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1.
Rev Col Bras Cir ; 47: e20202549, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578820

RESUMO

Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Humanos , Músculos Laríngeos/cirurgia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/normas , Gestão de Riscos/normas , Cirurgiões/normas , Traqueostomia/normas
2.
Endoscopy ; 52(6): 483-490, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32303090

RESUMO

We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.


Assuntos
Infecções por Coronavirus/transmissão , Endoscopia Gastrointestinal/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pneumonia Viral/transmissão , Gestão de Riscos/normas , Infecções por Coronavirus/prevenção & controle , Endoscopia Gastrointestinal/métodos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gestão de Riscos/métodos
3.
Rev Saude Publica ; 54: 21, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049211

RESUMO

OBJECTIVE: This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS). METHODS: This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median < 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach's alpha. RESULTS: The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ≤ 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (α = 0.94) and process dimension (α = 0.93), and adequate for the structural dimension (α = 0.70). CONCLUSIONS: The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.


Assuntos
Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Gestão de Riscos/métodos , Inquéritos e Questionários/normas , Adulto , Brasil , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Gestão de Riscos/normas
4.
BMC Palliat Care ; 19(1): 6, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918702

RESUMO

BACKGROUND: Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. METHODS: A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. RESULTS: One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. CONCLUSION: Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.


Assuntos
Guias como Assunto/normas , Cuidados Paliativos/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sujeitos da Pesquisa/psicologia , Gestão de Riscos/normas , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Gestão de Riscos/métodos , Gestão de Riscos/tendências
5.
Exp Parasitol ; 208: 107808, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765613

RESUMO

There is a plethora of meat-borne hazards - including parasites - for which there may be a need for surveillance. However, veterinary services worldwide need to decide how to use their scarce resources and prioritise among the perceived hazards. Moreover, to remain competitive, food business operators - irrespective of whether they are farmers or abattoir operators - are preoccupied with maintaining a profit and minimizing costs. Still, customers and trade partners expect that meat products placed on the market are safe to consume and should not bear any risks of causing disease. Risk-based surveillance systems may offer a solution to this challenge by applying risk analysis principles; first to set priorities, and secondly to allocate resources effectively and efficiently. The latter is done through a focus on the cost-effectiveness ratio in sampling and prioritisation. Risk-based surveillance was originally introduced into veterinary public health in 2006. Since then, experience has been gathered, and the methodology has been further developed. Guidelines and tools have been developed, which can be used to set up appropriate surveillance programmes. In this paper, the basic principles are described, and by use of a surveillance design tool called SURVTOOLS (https://survtools.org/), examples are given covering three meat-borne parasites for which risk-based surveillance is 1) either in place in the European Union (EU) (Trichinella spp.), 2) to be officially implemented in December 2019 (Taenia saginata) or 3) only carried out by one abattoir company in the EU as there is no official EU requirement (Toxoplasma gondii). Moreover, advantages, requirements and limitations of risk-based surveillance for meat-borne parasites are discussed.


Assuntos
Carne/parasitologia , Doenças Parasitárias/prevenção & controle , Gestão de Riscos/métodos , Animais , Prioridades em Saúde/classificação , Prioridades em Saúde/organização & administração , Humanos , Doenças Parasitárias/transmissão , Fatores de Risco , Gestão de Riscos/organização & administração , Gestão de Riscos/normas , Gestão de Riscos/tendências , Taenia saginata/isolamento & purificação , Teníase/prevenção & controle , Teníase/transmissão , Toxoplasma/isolamento & purificação , Toxoplasmose/prevenção & controle , Toxoplasmose/transmissão , Trichinella/isolamento & purificação , Triquinelose/prevenção & controle , Triquinelose/transmissão
7.
Am J Surg ; 219(1): 21-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31151660

RESUMO

BACKGROUND: Patient safety event reporting systems are a mainstay in non-punitive reporting of near misses and adverse events. We hypothesized that an upgraded reporting system that included the ability to report positive behaviors would increase behavioral reports in the perioperative environment. METHODS: We performed a retrospective assessment of prospectively collected reports from the Patient Safety Net (PSN) event reporting system (2/2010-2/2015) and the RL Solutions RL6 system (8/2015-4/2018). RESULTS: Under the PSN system, 0.8 behavioral events per quarter were submitted, compared to 7.4 behavioral events per quarter with the RL6 system. The average length of reports increased from 61 to 185 words. Reports were most often submitted by nursing staff (66%), and about attending physicians (36%). 22% of reports under the RL6 system were positive; 46% of these positive reports were about physicians. CONCLUSION: After implementation of an upgraded reporting system that includes an option for positive reporting, the number and length of reports increased. We believe that a robust reporting system has contributed to a culture of safety at our institution.


Assuntos
Segurança do Paciente/estatística & dados numéricos , Comportamento Problema , Gestão de Riscos/estatística & dados numéricos , Gestão de Riscos/normas , Humanos , Estudos Retrospectivos
8.
PLoS One ; 14(12): e0226261, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841543

RESUMO

BACKGROUND: After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer. OBJECTIVE: To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment. METHODOLOGY: A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis. FINDINGS: Two main themes emerged from the participants' experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of "risk treatment" for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors' surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women's personal and social lives and produced great uncertainty. CONCLUSIONS: This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women's lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients' personal wellbeing and social relations.


Assuntos
Neoplasia Intraepitelial Cervical , Medicalização , Aceitação pelo Paciente de Cuidados de Saúde , Percepção , Vigilância da População , Neoplasias do Colo do Útero , Adulto , Idoso , Atitude Frente a Saúde , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/psicologia , Neoplasia Intraepitelial Cervical/terapia , Continuidade da Assistência ao Paciente/normas , Progressão da Doença , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/psicologia , Feminino , Seguimentos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/normas , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/psicologia , Lesões Pré-Cancerosas/terapia , Fatores de Risco , Gestão de Riscos/métodos , Gestão de Riscos/normas , Comportamento Social , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/psicologia , Neoplasias do Colo do Útero/terapia , Adulto Jovem
9.
BMC Musculoskelet Disord ; 20(1): 504, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666054

RESUMO

Musculoskeletal disorders (MSDs) continue as one of the largest occupational health and safety problems worldwide. One reason for this situation is that current workplace risk management practices fail to meet some important evidence-based requirements for effective reduction of MSD risk. In particular: they largely fail to address risk arising from psychosocial hazards; do not allow sufficient participation by workers; and often fail to control risk at its sources.To address these deficiencies, A Participative Hazard Identification and Risk Management (APHIRM) toolkit has been formulated in accordance with both a framework developed by the World Health Organisation and implementation science principles. It comprises a set of online tools that include automated data analysis and reporting modules, and procedures to guide users through the five stages of the conventional risk management cycle. Importantly, it assesses both hazard and risk levels for groups of people doing a particular job, focusing on the job overall rather than only on tasks deemed to be hazardous. Its intended users are workplace managers and consultants responsible for occupational health and safety, with active participation from workers also. Resultant risk control interventions are customized to address the main physical and psychosocial hazards identified for the target job, and repetitions of the risk management cycle enables ongoing evaluation of outcomes in terms of both hazard and risk levels.


Assuntos
Análise de Dados , Medicina Baseada em Evidências/métodos , Doenças Musculoesqueléticas/terapia , Doenças Profissionais/terapia , Gestão de Riscos/métodos , Local de Trabalho , Medicina Baseada em Evidências/normas , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/prevenção & controle , Doenças Profissionais/diagnóstico , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador/normas , Gestão de Riscos/normas , Local de Trabalho/normas
10.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 58-66, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31767377

RESUMO

OBJECTIVE: Potential sources for errors or critical incidents in healthcare may arise not just within a healthcare facility, but also between healthcare facilities (e. g., in the communication between in- and outpatient care). This study aims to test the content validity of the reporting sheet and to optimize the cross-sectoral critical incident reporting system (CIRS-CS). METHOD: The CIRS-CS was developed as a part of the project "solimed ePflegebericht" based on the expertise of the participating organizations as well as existing literature and existing reporting systems (e. g., the recommendations of the "German Coalition for Patient Safety"). In addition, a pre-test was conducted among the organizations participating in the "solimed ePflegebericht" to assess the content validity of the reporting sheet. Content validity was assessed using cognitive interviews (N=11) with health professionals. The interviews were conducted on the basis of predefined scenarios and probing questions. RESULTS: The reporting sheet that was used for the pre-test consisted of 16 components such as reason for reporting/description of the problem, location of the patient at the time of reporting and suggested solution to the problem. The results of the pre-test indicated that participants found it challenging to relate to components such as In which type of healthcare service did the problem occur, What was the cause of the problem and Which factors contributed to the problem. For instance, some participants found it difficult to decide in which type of healthcare service (e. g., emergency care, routine care) the underlying problem occurred as this component could be reported from different perspectives, i. e. where the incident arose versus where the problem occurred. Thus, depending on the interpretation of this component, the participants questioned the feasibility since there was a lack of knowledge as to under which circumstances the incident arose. CONCLUSION: The results of the pre-test of the CIRS-CS suggest that the description of the causes as well as potential solutions via the cross-sectoral reporting sheet is unfeasible and may be better approached with an interdisciplinary investigation team panel as part of the reporting system, in which the participating representatives are able to enter a structured dialogue based on the reported problems. Furthermore, the results indicate that investigation team panels enable an interprofessional exchange and may thus promote transparency between healthcare facilities. At this point, there is little research on the content validity of reporting sheets for cross-sectoral reporting systems. Hence, our results may contribute to the development of comprehensible and feasible cross-sectoral CIRS.


Assuntos
Assistência à Saúde , Serviços Médicos de Emergência , Segurança do Paciente , Gestão de Riscos , Lista de Checagem , Alemanha , Humanos , Gestão de Riscos/métodos , Gestão de Riscos/normas , Autoavaliação
11.
J Trauma Nurs ; 26(6): 297-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31714490

RESUMO

Despite increasing attention to concussion safety, many young athletes still do not report concussion-like symptoms to athletic staff. This systematic review was conducted to identify barriers and facilitators to reporting of concussions by high school and collegiate athletes. The review was conducted using PubMed, SCOPUS, CINAHL Complete, and Cochrane Library. Original research articles were deemed eligible if they contained either qualitative or quantitative data on barriers and facilitators of high school and collegiate athletes self-reporting concussion symptoms to athletic staff. For those articles that met inclusion criteria, both authors critically read each article, summarized reasons given by the authors, and then categorized this information into a barrier or a facilitator of concussion-reporting behavior. Of the 878 articles returned, 24 articles met inclusion criteria. Major facilitators were female sex and younger age. Major barriers were a fear of losing current or future playing time, a misconception that concussive injury is not serious, a fear of letting one's team down, and a lack of knowledge of concussion signs and symptoms. Future interventions should address these issues, incorporate primary and secondary prevention strategies, and emphasize the long-term risks of playing while concussed.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Guias de Prática Clínica como Assunto , Gestão de Riscos/estatística & dados numéricos , Gestão de Riscos/normas , Estudantes/estatística & dados numéricos , Adolescente , Atletas/psicologia , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Currículo , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Estudantes/psicologia , Adulto Jovem
13.
Int J Med Inform ; 132: 103971, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630063

RESUMO

CONTEXT: Adverse events in healthcare are often collated in incident reports which contain unstructured free text. Learning from these events may improve patient safety. Natural language processing (NLP) uses computational techniques to interrogate free text, reducing the human workload associated with its analysis. There is growing interest in applying NLP to patient safety, but the evidence in the field has not been summarised and evaluated to date. OBJECTIVE: To perform a systematic literature review and narrative synthesis to describe and evaluate NLP methods for classification of incident reports and adverse events in healthcare. METHODS: Data sources included Medline, Embase, The Cochrane Library, CINAHL, MIDIRS, ISI Web of Science, SciELO, Google Scholar, PROSPERO, hand searching of key articles, and OpenGrey. Data items were manually abstracted to a standardised extraction form. RESULTS: From 428 articles screened for eligibility, 35 met the inclusion criteria of using NLP to perform a classification task on incident reports, or with the aim of detecting adverse events. The majority of studies used free text from incident reporting systems or electronic health records. Models were typically designed to classify by type of incident, type of medication error, or harm severity. A broad range of NLP techniques are demonstrated to perform these classification tasks with favourable performance outcomes. There are methodological challenges in how these results can be interpreted in a broader context. CONCLUSION: NLP can generate meaningful information from unstructured data in the specific domain of the classification of incident reports and adverse events. Understanding what or why incidents are occurring is important in adverse event analysis. If NLP enables these insights to be drawn from larger datasets it may improve the learning from adverse events in healthcare.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Registros Eletrônicos de Saúde/tendências , Processamento de Linguagem Natural , Gestão de Riscos/classificação , Gestão de Riscos/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Registros Eletrônicos de Saúde/normas , Humanos
15.
Eur Arch Otorhinolaryngol ; 276(10): 2947-2951, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321501

RESUMO

PURPOSE: The purpose of this study was to examine the malpractice litigations pertaining to otorhinolaryngology in Japan. METHODS: A retrospective review was undertaken of cases tried in the Japanese civil court system during the 26-year period from 1990 to 2015 as identified in a computerized legal database. Data including patient demographics, disease, chief allegations, court's decisions, and the year decision was made were collected and analyzed. Patients' chief allegations were assigned to one of the five categories: delayed diagnosis, complication during diagnostic procedure, inappropriate treatment, complication during treatment procedure, or lack of informed consent. RESULTS: Thirty-one malpractice litigations were identified. Eight (26%) malpractice litigations pertained to tumors, 1 (3%) to a tumor-like lesion, 14 (45%) to inflammation, and 8 (26%) to others. Among the patients' chief allegations, inappropriate treatment and complication during treatment procedure were the most frequent [11 (36%) for each], followed by delayed diagnosis [6 (19%)], complication during diagnostic procedure [2 (6%)], and lack of informed consent [1 (3%)]. CONCLUSION: These data may aid in the design of risk-prevention strategies to be used by otorhinolaryngologists.


Assuntos
Imperícia , Otolaringologia , Gestão de Riscos/normas , Humanos , Japão , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Otolaringologia/legislação & jurisprudência , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos
16.
J Nurs Manag ; 27(7): 1454-1461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306522

RESUMO

AIM: To develop and expand how nurses promote safety in perioperative settings. BACKGROUND: This article presents orchestrating a sub-core category from the theory of anticipatory vigilance in promoting safety within preoperative settings (Journal of Clinical Nursing, 27, 2018, 247). Orchestrating explains this and involves effective planning, delegating, co-ordinating and communication. METHOD: A classic grounded theory methodology was used. Ethical approval was granted. Data comprised of 37 interviews and 33 hr of non-participant observation. Data analysis followed the principals of classic grounded theory. RESULTS: Orchestrating is fundamental in promoting safety and minimizing risk of errors and adverse events in the perioperative setting. Nurses achieve this through four categories: macro orchestrating, locational orchestrating, situational orchestrating and being in the know. CONCLUSION(S): Nurses minimize risk by fostering a culture of safety, risk awareness, effective management and leadership. IMPLICATIONS: Effective management structures and support systems are essential in promoting a culture of safety in perioperative setting.


Assuntos
Enfermeiras e Enfermeiros/normas , Segurança do Paciente/normas , Período Perioperatório , Gestão de Riscos/métodos , Teoria Fundamentada , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Gestão de Riscos/normas
18.
Occup Med (Lond) ; 69(6): 436-440, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31247108

RESUMO

BACKGROUND: Needlestick injuries (NSIs) are common healthcare-related injuries and possible consequences include blood-borne infections. Despite that, a large proportion of NSIs are not reported. AIMS: To estimate the prevalence of under-reporting of NSIs and to evaluate the knowledge, attitude and behaviour towards NSIs among junior doctors in a tertiary hospital in Singapore. METHODS: An explanatory sequential mixed-methods design was employed. Quantitative data were collected through questionnaires completed by 99 junior doctors. Descriptive statistics and bivariate analysis were performed to evaluate socio-demographic characteristics, NSI history and NSI reporting practices. Qualitative data were collected through 12 in-depth interviews. Participants were purposively recruited, and semi-structured topic guides were developed. Data were analysed using a thematic approach. RESULTS: Fifty-two per cent of respondents had history of NSI. Of those with history of NSI, 31% did not report injury. NSI reporters were 1.52 times as likely to be aware of how to report injury (P < 0.05), and 1.63 times as likely to feel that reporting benefits their health (P < 0.01) compared with non-reporters. NSI reporters were 83% more likely to report a clean NSI (P = 0.05). For non-reporters, the main reasons for not reporting were perceived low risk of transmission (41%) and lack of time to report (35%). Themes identified in the qualitative data include perceived benefits, perceived barriers, perceived threats, cues to action and organizational culture. CONCLUSION: Under-reporting of NSIs may have significant implications for patients and healthcare workers. Addressing identified factors and instituting targeted interventions will help to improve reporting rates.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Gestão de Riscos/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Singapura/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
19.
Integr Environ Assess Manag ; 15(5): 714-725, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31144769

RESUMO

Pesticide regulation requires regulatory authorities to assess the potential ecological risk of pesticides submitted for registration, and most risk assessment schemes use a tiered testing and assessment approach. Standardized ecotoxicity tests, environmental fate studies, and exposure models are used at lower tiers and follow well-defined methods for assessing risk. If a lower tier assessment indicates that the pesticide may pose an ecological risk, higher tier studies using more environmentally realistic conditions or assumptions can be performed to refine the risk assessment and inform risk management options. However, there is limited guidance in the United States on options to refine an assessment and how the data will be incorporated into the risk assessment and risk management processes. To overcome challenges to incorporation of higher tier data into ecological risk assessments and risk management of pesticides, a workshop was held in Raleigh, North Carolina. Attendees included representatives from the United States Environmental Protection Agency, United States Department of Agriculture, National Oceanic and Atmospheric Administration, universities, commodity groups, consultants, nonprofit organizations, and the crop protection industry. Key recommendations emphasized the need for 1) more effective, timely, open communication among registrants, risk assessors, and risk managers earlier in the registration process to identify specific protection goals, address areas of potential concern where higher tier studies or assessments may be required, and if a higher tier study is necessary that there is agreement on study design; 2) minimizing the complexity of study designs while retaining high value to the risk assessment and risk management process; 3) greater transparency regarding critical factors utilized in risk management decisions with clearly defined protection goals that are operational; and 4) retrospective analyses of success-failure learnings on the acceptability of higher tier studies to help inform registrants on how to improve the application of such studies to risk assessments and the risk management process. Integr Environ Assess Manag 2019;15:714-725. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).


Assuntos
Agricultura/legislação & jurisprudência , Regulamentação Governamental , Guias como Assunto , Praguicidas/toxicidade , Gestão de Riscos/normas , Medição de Risco/normas , Estados Unidos
20.
J Nurs Manag ; 27(6): 1176-1181, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31077621

RESUMO

AIM: To identify workplace factors that influence patient advocacy among registered nurses (RNs) and their willingness to report unsafe practices. BACKGROUND: A prior study by Black illustrated that 34% of respondents were aware of conditions that may have caused patient harm but had not reported the issue. The most common reasons identified for failing to report issues were fear of retaliation and a belief that nothing would prevail from the reports. METHOD: Using Black's study as a model, reporting data were collected from a sample of RNs actively practicing in acute care hospitals. RESULTS: While reasons for reporting are consistent with Black's study, data suggest that a nurse's experiences and working environment are prime factors in their willingness to report patient care issues. CONCLUSION: Although RNs may not have personally experienced workplace retaliation, fear of retaliation when reporting unsafe patient care practices still exists. Nursing leadership's ability to facilitate a culture of safety by proactively addressing unsafe practices fosters a level of comfort for patient advocacy and willingness to report issues. Education, professional associations and existing protection laws are available resources which contribute to organizational support systems. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study are consistent with the literature in that organizations need to create a supportive workplace environment whereby, through collective input and leadership, reporting protocols are in place that empower RNs to report unsafe conditions. Direct care nurses are positioned, especially well to identify and speak up regarding conditions that may result in near misses or actual adverse events. Therefore, it is the responsibility, and duty, of nursing management to create and facilitate reporting systems that will be utilized without fear of retaliation and that will contribute to a culture of safety and patient advocacy.


Assuntos
Atitude do Pessoal de Saúde , Gestão de Riscos/normas , Local de Trabalho/psicologia , Adulto , Coragem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Cultura Organizacional , Defesa do Paciente/psicologia , Defesa do Paciente/normas , Inquéritos e Questionários , Local de Trabalho/normas
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