Other bulletins in this series include:

Breast Surgery

Thursday, 30 April 2009

Medication errors in an intensive care unit

Medication errors in an intensive care unit.
Bohomol, E., Ramos, L.H., D'Innocenzo, M.

Report of a study to investigating the incidence types and causes of medication errors (MEs) and the consequences for patients. Background. Medication errors are a common problem in hospitals around the world, including those in Brazil.Method. An exploratory, quantitative survey design was used and 44 adult inpatients were studied over a 30-day period in 2006. Findings. A total of 305 MEs was observed. Conclusion. There is a need to develop a culture of safety and quality in patient care. An understanding of the profile of ME types and frequencies in an institution is fundamental to raise awareness and implement measures to avoid them. Structural and procedural changes in hospital organization, with a focus on the efficacy, efficiency, and effectiveness of the medication system are needed to reduce MEs.

Infection, prevention and control

Infection, prevention and control
Theory and practice for healthcare professionals [Book]
Debbie Wilson
614.48 Macc HS Library

Tuesday, 28 April 2009

End of life treatment and care: good practice in decision-making - a consultation

End of life treatment and care: good practice in decision-making - a consultation

The General Medical Council (GMC) is consulting on new draft guidance, 'End of life treatment and care: good practice in decision-making'. The guidance is intended mainly for doctors but may also help patients and the public and other health and social care staff to understand what they can expect from doctors involved in caring for patients who are dying. The consultation runs until 13 July 2009. (GMC - news)

Hand hygiene adherence is influenced by the behavior of role models.

Pediatr Crit Care Med. 2009 Mar 25. [Epub ahead of print] LinkOut
Hand hygiene adherence is influenced by the behavior of role models.
Schneider J, Moromisato D, Zemetra B, Rizzi-Wagner L, Rivero N, Mason W, Imperial-Perez F, Ross L.

From the Department of Anesthesiology Critical Care Medicine (JS, DM, BZ, LR-W, NR, FI-P); Division of Infectious Diseases (WM, LR); Department of Pediatric Critical Care Medicine (JS), Childrens Hospital Los Angeles, Los Angeles, CA.

OBJECTIVE:: Proper hand hygiene (HH) reduces nosocomial infections. Therefore, factors that influence HH behavior of healthcare workers are of great interest. We hypothesized that strict HH adherence by supervisor role models would improve the HH behavior of junior staff.

DESIGN:: Prospective observational study.
SETTING:: Pediatric and cardiac intensive care units of a tertiary care children's hospital. SUBJECTS:: Two critical care fellows and four nurse orientees.
INTERVENTIONS:: First, we observed and recorded HH adherence of the fellows and nurse orientees and their respective supervising attending physician or nurse preceptor during daily patient care. Subsequently, we paired the same fellows and nurse orientees with a different supervisor who maintained strict HH adherence, and again noted HH adherence. We used measures of HH opportunities and HH adherence consistent with guidelines set by the Centers for Disease Control and Association for Professionals in Infection Control and Epidemiology.

MEASUREMENTS AND MAIN RESULTS:: HH adherence by fellows and nurse orientees at baseline was 22% of 200 HH opportunities, and improved to 56% of 234 opportunities as a result of role modeling-an average increase of 34% points (95% confidence interval, 18.7-51; p < 0.01 by linear regression), representing a HH adherence rate greater than 1.5 times that of the baseline. The control senior practitioners' HH adherence rate was 20% of 180 opportunities compared with the study senior practitioners' HH adherence of 94% of 187 opportunities-an average difference of 72%points higher compared with the control senior practitioners (95% confidence interval, 56-88.3; p < 0.01 by linear regression).

CONCLUSIONS:: HH adherence of junior practitioners improved under the supervision of adherent role models. These results suggest that HH behavior of senior practitioners plays a crucial influence on other staff. Senior healthcare practitioners should consider the important role they may play in reinforcing or weakening a culture of patient safety and proper HH.
PMID: 19325501 [PubMed - as supplied by publisher]