A checklist for patient safety rounds at the care pathway level

Objective - To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design - We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. Setting and Participants - A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. Main outcome measures - Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). Results - Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. Conclusion - The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

Fisheries Safety Management

Fisheries is one of the most dangerous professions in the world. Fatal accidents and injuries in the fisheries are characterized as well as particular circumstances that may cause or aggravate the risk of accidents. Aspects of safety management of fishing vessels are covered in this paper: areas of concern when doing a risk assessment in fishing vessels, fundamental elements on a safety management system for the fisheries and the need for international and national level instruments as well as legal and compulsory measures

An approach to health and safety in E.U. forestry operations – Hazards and preventive measures

Forestry in general and logging in particular continue to be among the three most hazardous sectors in European countries. The aim of this article is to characterize health and safety problems and solutions in E.U. forestry operations, and particularly in Portuguese operations. Forest types, production, employment and ownership are used to characterize the forest sector. Forestry accidents and health problems data are mentioned. Typical hazards associated to the nature of logging operations are systematized. Preventive measures, focused on a wide spectrum of measures, making safety considerations an integral feature of all operational activities from planning to organization to execution and supervision of work are emphasized in this article.

Safety and efficacy of fenproporex for obesity treatment: a systematic review

ABSTRACT OBJECTIVE To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. METHODS MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to treat obesity. RESULTS Only four controlled studies met the inclusion criteria. One randomized, placebo-controlled trial on Fenproporex was found on electronic databases. Three placebo-controlled studies (in non-indexed journals) were identified by hand-searching. Patients with cardiovascular and other comorbidities were excluded in all studies. Trials lasted from 40 to 364 days and doses ranged from 20 to 33.6 mg/d. All controlled studies found that weight loss among Fenproporex-treated patients was greater than that produced by the placebo, but drug effect was modest. Fenproporex produced additional weight reductions of 4.7 kg (one year), 3.8 kg (six months) and 1.55 kg (two months) in average, in relation to diet and exercise only (three trials). Insomnia, irritability, and anxiety were the most frequently reported side effects in the four studies. CONCLUSIONS There is a paucity of randomized, placebo-controlled trials on Fenproporex and those identified here present major methodological flaws. These studies suggest that Fenproporex is modestly effective in promoting weight loss. Nonetheless, they failed to provide evidence that it reduces obesity-associated morbidity and mortality. Data from these studies are insufficient to determine the risk-benefit profile of Fenproporex. Abuse potential and amphetamine-like adverse effects are causes for concern.

Aplicação do Método SFA (Safety Function Analisys) a um. Posto de Transformação de Energia Eléctrica da Renova

Riscos Industriais e Emergentes, 2009 pp. 827-844

Portuguese strategy for occupational safety and health 2008-2012 for public administration : priorites for action, progress in the implementation of the proposed measures and their impact on occupational safety outcomes

Apresentação realizada no OH&S Forum 2011 - International Forum on Occupational Health and Safety: Policies, profiles and services, na Finlândia de, 20 a 22 Junho de 2011.

Fire safety barrier availability analysis

This paper shows several ways to analyse the performance of a safety barrier, depending on the objective to be achieved and present a method to analyse binary components usually present on sensor systems of safety barriers. An application example of a water-based fire system is presented and the Probability of Failure on Demand (PFD) of the sensor system is determined based on the analysis of pressure switches installed in this safety barrier. The knowledge of such information will allow the determination of safety barrier’s availability.

Safety climate and its relationship with furniture companies’ safety performance and workers’ risk acceptance

This study aims to analyse the relationship between safety climate and the level of risk acceptance, as well as its relationship with workplace safety performance. The sample includes 14 companies and 403 workers. The safety climate assessment was performed by the application of a Safety Climate in Wood Industries questionnaire and safety performance was assessed with a checklist. Judgements about risk acceptance were measured through questionnaires together with four other variables: trust, risk perception, benefit perception and emotion. Safety climate was found to be correlated with workgroup safety performance, and it also plays an important role in workers’ risk acceptance levels. Risk acceptance tends to be lower when safety climate scores of workgroups are high, and subsequently, their safety performance is better. These findings seem to be relevant, as they provide Occupational, Safety and Health practitioners with a better understanding of workers’ risk acceptance levels and of the differences among workgroups.

Safety and immunogenicity of hepatitis B vaccine ButaNG in adults

Recombinant yeast-derived hepatitis B vaccine manufactured by Instituto Butantan was administered in two groups of adult volunteers (I, II) following two different schedules of immunization. In the first trial (10 mg doses and 0, 1, 3 months vaccination schedule) 106 individuals completed the full immunization program. The results of seroconversion by age group varied from 70 to 100% and the GMT from 46.5 to 124.9 mIU mL-1. In the second trial with 68 individuals (for dosage comparison and 0, 1, 6 months vaccination schedule) indicated that the vaccine formulated in 20 mg was more effective than in 10 mg. The adverse reactions observed in the vaccinees were less frequent than the ones previously found since the introduction of similar vaccines.

The patient safety journey in Portugal : challenges and opportunities from a public health perspective

ABSTRACT - Despite improvements in healthcare interventions, the incidence of adverse events and other patient safety problems constitutes a major contributor to the global burden of diseases and a concern for Public Health. In the last years there have been some successful individual and institutional efforts to approach patient safety issues in Portugal, unless such effort has been fragmented or focused on specific small areas. Long-term and global improvement has remained elusive, and most of all the improvement of patient safety in Portugal, must evaluate not only the efficacy of a change but also what was effective for implementing the change. Clearly, patient safety issues result from various combinations of individual, team, organization, system and patient factors. A systemic and integrated approach to promote patient safety must acknowledge and strive to understand the complexity of work systems and processes in health care, including the interactions between people, technology, and the environment. Safety errors cannot be productively attributed to a single human error. Our objective with this paper is to provide a brief overview of the status quo in patient safety in Portugal, highlighting key aspects that should be taken into account in the design of a strategy for improving patient safety. With these key aspects in mind, policy makers and implementers can move forward and make better decisions about which changes should be made and about the way the needed changes to improve patient safety should be implemented. The contribution of colleagues that are international leaders on healthcare quality and patient safety may also contribute to more innovative research methods needed to create the knowledge that promotes less costly successful changes.---- ---------------------- RESUMO – As questões relacionadas com a Segurança do Doente, e em particular, com a ocorrência de eventos adversos tem constituído, de há uns tempos a esta parte, uma crescente preocupação para as organizações de saúde, para os decisores políticos, para os profissionais de saúde e para os doentes/utentes e suas famílias, sendo por isso considerado um problema de Saúde Pública a que urge dar resposta. Em Portugal, nos últimos anos, têm sido desenvolvidos esforços baseados, maioritariamente, em iniciativas isoladas, para abordar os aspectos da Segurança do Doente. O facto de essas iniciativas não serem integradas numa estratégia explícita e de dimensão regional ou nacional, faz com que os resultados sejam parcelares e tenham visibilidade reduzida. Paralelamente, a melhoria da qualidade dos cuidados de saúde (a longo prazo) resultante dessas iniciativas tem sido esparsa e nem sempre a avaliação tem sido feita tendo em conta critérios de efectividade e de eficiência. A Segurança do Doente resulta da interacção de diversos factores relacionados, por um lado, com o doente e, por outro, com a prestação de cuidados que envolvem elementos de natureza individual (falhas activas) e organizacional/estrutural (falhas latentes). Devido à multifactorialidade que está na base de «problemas/falhas» na Segurança do Doente, qualquer abordagem a considerar deve ser sistémica e integrada. Simultaneamente, tais abordagens devem contemplar a compreensão da complexidade dos sistemas e dos processos de prestação de cuidados de saúde e as suas interdependências (envolvendo aspectos individuais, tecnológicos e ambientais). O presente trabalho tem por objectivo reflectir sobre o «estado da arte» da Segurança do Doente em Portugal, destacando os elementos-chave que se consideram decisivos para uma estratégia de acção nesse domínio. Com esses elementos os responsáveis pela governação da saúde poderão valorizar os aspectos que consideram decisivos para uma política de Segurança do Doente mais eficaz. A contribuição de quatro colegas internacionalmente reconhecidos como líderes na área da Qualidade em Saúde e da Segurança do Doente, constitui, por certo, uma oportunidade ímpar para a identificação e discussão de alguns dos principais desafios, ameaças e oportunidades que s

Toward a Run-Time Verification Framework for Real-Time Safety-Critical Systems

Presented at SEMINAR "ACTION TEMPS RÉEL:INFRASTRUCTURES ET SERVICES SYSTÉMES". 10, Apr, 2015. Brussels, Belgium.

A New Electronic Approach for the Surgical Safety Checklist

To improve surgical safety, and to reduce the mortality and surgical complications incidence, the World Health Organization (WHO) developed the Surgical Safety Checklist (SSC). The SSC is a support of information that aids health professionals to reduce the number of complications, induction of anaesthesia, period before skin incision and period before leaving the operating room (OR). The SSC was tested in several countries of the world and their results shown that after introduction of the SSC the incidence of patient complication lowered from 11.0% to 7.0% (P<0.001), the rate of death declined from 1.5% to 0.8% (P = 0.003) and the nurses recognized that patients identity was more often con rmed (81.6% to 94.2%, P<0.01) in many institutions. Recently the SSC was also implemented in Portuguese hospitals, which led us to its study in the real clinical environment. An observational study was performed: several health professionals were observed and interviewed, to understand the functioning of the SSC in an OR, during the clinical routine. The objective of this study was to understand the current use of the SSC, and how it may be improved in terms of usability, taking advantage of the technological advancements such as mobile applications. During two days were observed 14 surgeries, only 2 surgeries met the requirements for the three phases of the SSC, as de ned by the WHO. Of the remaining 12 observed surgeries, 9 surgeries completed the last phase at the correct time. It was also observed that only in 2 surgeries all the phases of the SSC were read aloud to the team and that, in 7 surgeries, several items were read aloud and answered but no one was checking the SSC, only after the end of the phase. The observational study results disclose that several health professionals do not meet with rules of the WHO manual. This study demonstrates that it is urgent to change the mindset of health professionals, and that di erent features in the SSC may be useful to make it more easy to use. With the results of the observational study, a SSC application proposal was developed with new functionalities to improve and aid the health professional in its use. In this application the user can chose between a SSC already created to a speci c surgery or to create a new SSC, adding and adapting some questions from the WHO standard. To create a new SSC, the application is connected to an online questionnaire builder (JotForm). The choice for this online questionnaire builder went through three essential characteristics: number of types of questions, mainly checkbox, radio button and text; the possibility of to create sections inside sections and the API. In addition, in this proposal the improvements are focused in forcing the user to focus in the work ow of the SSC and to save the input timestamps and any actions made by them. Therefore, the following features was implemented to achieve that goal: display one item of the SSC at a time; display the stage where the SSC is; do not allow going back to the previous step; do not allow going forward to the next item if the current is not lled; do not allow going forward to the next item if the time it took to ll the item was too short and log any action made by the user.

Multilevel model of safety climate for furniture industries

BACKGROUND: Furniture companies can analyze their safety status using quantitative measures. However, the data needed are not always available and the number of accidents is under-reported. Safety climate scales may be an alternative. However, there are no validated Portuguese scales that account for the specific attributes of the furniture sector. OBJECTIVE: The current study aims to develop and validate an instrument that uses a multilevel structure to measure the safety climate of the Portuguese furniture industry. METHODS: The Safety Climate in Wood Industries (SCWI) model was developed and applied to the safety climate analysis using three different scales: organizational, group and individual. A multilevel exploratory factor analysis was performed to analyze the factorial structure. The studied companies’ safety conditions were also analyzed. RESULTS: Different factorial structures were found between and within levels. In general, the results show the presence of a group-level safety climate. The scores of safety climates are directly and positively related to companies’ safety conditions; the organizational scale is the one that best reflects the actual safety conditions. CONCLUSIONS: The SCWI instrument allows for the identification of different safety climates in groups that comprise the same furniture company and it seems to reflect those groups’ safety conditions. The study also demonstrates the need for a multilevel analysis of the studied instrument.

Safety and skin delayed-type hypersensitivity response in vervet monkeys immunized with Leishmania donovani sonicate antigen delivered with adjuvants

In this study, we report on the safety and skin delayed-type hypersensitivity (DTH), responses of the Leishmania donovani whole cell sonicate antigen delivered in conjunction with alum-BCG (AlBCG), Montanide ISA 720 (MISA) or Monophosphoryl lipid A (MPLA) in groups of vervet monkeys. Following three intradermal injections of the inoculums on days 0, 28 and 42, safety and DTH responses were assessed. Preliminary tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) levels were also measured and these were compared with DTH. Only those animals immunized with alum-BCG reacted adversely to the inoculum by producing ulcerative erythematous skin indurations. Non-parametric analysis of variance followed by a post-test showed significantly higher DTH responses in the MISA+Ag group compared with other immunized groups (p < 0.001). The MPLA+Ag group indicated significantly lower DTH responses to the sonicate antigen compared with the AlBCG+Ag group. There was a significant correlation between the DTH and cytokine responses (p < 0.0001). Based on this study we conclude that Leishmania donovani sonicate antigen containing MISA 720 is safe and is associated with a strong DTH reaction following immunization.