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Patient-Centered Healthcare: From Patient Experience to Human Experience 以患者为中心的医疗保健:从患者体验到人类体验
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-x2
Muhammad Hasan Abid, Augustine Kumah, Ahmed Newera, Passant Hafez
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引用次数: 0
Using the Failure Mode and Effect Analysis Tool to Improve the Automatic Stop Order Process 使用故障模式和影响分析工具改进自动停止命令流程
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-9
Ghada Hussain Al Mardawi, R. Rajendram, Arwa Balharith, Abdulaziz Alomaim
Automatic stop orders (ASOs) in computerized prescription order entry (CPOE) systems predefine the length of treatment. This can improve resource use for select therapies (e.g., empirical antibiotics). However, root cause analysis of dose omission errors identified inappropriate ASO-directed termination of medications without prescriber notification. This quality improvement initiative aimed to identify potential failures of the medication ASO processes to develop a new workflow and anticipate issues that may arise after implementation. A failure mode and effect analysis (FMEA) was conducted following Institute of Healthcare Improvement guidance. A multidisciplinary ASO-FMEA team reviewed the existing workflow. Failure modes, risk priority numbers (RPNs), and interventions were identified and assessed. The RPNs calculated for the proposed new workflow (assuming all recommendations were implemented) were compared with those of the existing workflow. Eight failure modes, 17 effects, and 31 causes were identified in the five workflow steps (mean RPN 365.4; median 280). Specific, measurable, achievable, realistic, and time-bound interventions were proposed. Assuming successful implementation of all recommendations, the RPNs of the proposed workflow (mean 117.6; median 112) were significantly lower (p < 0.05). When modifying existing CPOE systems, FMEA may identify possible failures that can be addressed before the implementation of a new process. This may prevent errors, improving medication safety. Regardless, continuous audit and monitoring are required to ensure the effectiveness of implemented changes.
计算机化处方单输入(CPOE)系统中的自动停止处方单(ASO)可预先确定治疗时间。这可以提高特定疗法(如经验性抗生素)的资源利用率。然而,对剂量遗漏错误的根本原因分析发现,在未通知处方医生的情况下,存在不适当的 ASO 定向终止用药的情况。这项质量改进措施旨在找出用药 ASO 流程的潜在故障,以制定新的工作流程,并预测实施后可能出现的问题。 根据美国医疗保健改进研究所的指导,进行了故障模式和影响分析(FMEA)。一个多学科的 ASO-FMEA 小组审查了现有的工作流程。确定并评估了故障模式、风险优先级(RPN)和干预措施。将为建议的新工作流程(假设所有建议都已实施)计算出的 RPN 与现有工作流程的 RPN 进行了比较。 在五个工作流程步骤中确定了 8 种故障模式、17 种影响和 31 种原因(平均 RPN 为 365.4;中位数为 280)。提出了具体的、可衡量的、可实现的、现实的和有时限的干预措施。假定成功实施所有建议,建议工作流程的 RPN(平均值 117.6;中位数 112)将显著降低(p < 0.05)。 在修改现有 CPOE 系统时,FMEA 可以发现可能存在的故障,从而在实施新流程之前解决这些故障。这可以防止错误发生,提高用药安全。无论如何,都需要进行持续的审核和监控,以确保所实施更改的有效性。
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引用次数: 0
Letter in Response to “Lomitapide: A Medication Use Evaluation and a Formulary Perspective” by Esba and Alharbi 回应 Esba 和 Alharbi 所著《洛米他匹:Esba 和 Alharbi 撰写的 "洛米他匹:用药评估和处方集视角 "的回复
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-17
Dirk J. Blom
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引用次数: 0
Adopting the "TDODAR" Model to Improve Clinical Decision-Making in Acute and Critical Care Settings. 采用 "TDODAR "模式改进急危重症护理中的临床决策。
Pub Date : 2024-06-24 eCollection Date: 2025-02-01 DOI: 10.36401/JQSH-24-14
Isaac K S Ng
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引用次数: 0
Factors Associated with Antidiabetic Medications and Dietary Recommendation Adherence Among Patients with Type 2 Diabetes. 2型糖尿病患者抗糖尿病药物和饮食推荐依从性相关因素
Pub Date : 2024-06-17 eCollection Date: 2025-02-01 DOI: 10.36401/JQSH-23-52
Godwin Gideon Kwaku Dorvlo, Augustine Kumah, Samuel Kwabena Ofosu, Stephen Henry Afakorzi, Yvette Eyram Avorgbedor, Emmanuel Obot, Chinwe Nnenna Nwogu, Malik Abdul Rahman, Henry Okorie Ugorji, Lawrencia Antoinette Aidoo, Anthony Bless Dogbedo, Abdul-Razak Issah, Abigail Abiba Fuseini, Deborah Terkperkie Kanamitie, Gustav Boni

Introduction: Diabetes mellitus is a global noncommunicable disease epidemic of public concern. Adherence poses a challenge to patients due to the long-term management of type 2 diabetes. This study assessed the factors associated with antidiabetic medications and dietary recommendation adherence among patients with type 2 diabetes in Ghana.

Methods: A hospital-based, cross-sectional study design was used to assess self-reported factors associated with antidiabetic medications and dietary recommendation adherence among 165 recruited type 2 diabetes patients who visited diabetic clinics of two selected municipal hospitals in the Volta region of Ghana. A structured questionnaire consisting of closed-ended questions was used. Phone calls were used to collect responses from participants using the structured questionnaire, which included the United Kingdom Diabetes Diet Questionnaire and Morisky Adherence Scale. Data collected were entered into a Microsoft Excel sheet and exported to STATA software (version 15) to analyze variables. Binary logistic regression was run to determine the association between the level of adherence (outcome variable) and the independent variables. A CI of 95% with a p-value of < 0.05 was statistically significant.

Results: Self-reported factors were as follows: forgetfulness (p = 0.0001), taking medication (p = 0.006), difficulty remembering to take medication (p = 0.001), worry about long-term intake of drugs (p = 0.0001), choice of high-fiber diet (p = 0.037), intake of processed or refined carbohydrate (p = 0.049) alcohol intake (p = 0.033), age (p = 0.015), occupation (p = 0.009), and patient waiting time (p = 0.020) were found to have contributed to medication/dietary nonadherence among the participants.

Conclusion: Patient adherence was low. Health authorities in the two selected hospitals should develop strategies to reduce the problem of poor adherence.

简介:糖尿病是一种全球普遍关注的非传染性流行病。由于2型糖尿病的长期管理,依从性对患者提出了挑战。本研究评估了与加纳2型糖尿病患者抗糖尿病药物和饮食建议依从性相关的因素。方法:采用以医院为基础的横断面研究设计,对165名在加纳Volta地区两家选定的市立医院的糖尿病诊所就诊的2型糖尿病患者进行自我报告,评估与抗糖尿病药物和饮食推荐依从性相关的因素。采用由封闭式问题组成的结构化问卷。通过电话收集参与者使用结构化问卷的回答,其中包括英国糖尿病饮食问卷和莫里斯基坚持量表。将收集到的数据输入到Microsoft Excel表格中,并导出到STATA软件(版本15)进行变量分析。采用二元逻辑回归来确定依从性水平(结果变量)与自变量之间的关系。CI为95%,p值< 0.05,具有统计学意义。结果:自述因素如下:健忘(p = 0.0001)、服药(p = 0.006)、难以记住服药(p = 0.001)、担心长期服用药物(p = 0.0001)、选择高纤维饮食(p = 0.037)、摄入加工或精制碳水化合物(p = 0.049)、摄入酒精(p = 0.033)、年龄(p = 0.015)、职业(p = 0.009)和患者等待时间(p = 0.020)是导致参与者不遵守药物/饮食的原因。结论:患者依从性较低。选定的两家医院的卫生当局应制定战略,以减少依从性差的问题。
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引用次数: 0
Practical Application for the Theory of Profound Knowledge in a Quality Improvement Project 深奥知识理论在质量改进项目中的实际应用
Pub Date : 2024-05-06 DOI: 10.36401/jqsh-23-45
Hakem Alomani, F. A. Mostafa, Basim Felemban, Hani Redwan, Khaled Masaud, Khadijah Alshanqiti, Claudine Neff, Matea Vidovic
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引用次数: 0
Evaluation of a Risk Screening Checklist for Venous Thromboembolism Prophylaxis in a Women and Newborn Hospital 评估一家妇女和新生儿医院的静脉血栓栓塞预防风险筛查清单
Pub Date : 2024-05-03 DOI: 10.36401/jqsh-23-51
Rebecca Lewis, Deborah Gordon, Julie Lam, S. Teoh, T. Lebedevs
The venous thromboembolism (VTE) risk screening forms were developed to allow for recording identified risk factors for VTE including thrombophilia, history of VTE, postpartum hemorrhage, and cesarean delivery, and documentation of specific actions taken to mitigate these risks and reduce complications due to VTE. Compliance with hospital guidelines in assessing VTE risk and appropriate prescribing of thromboprophylaxis was evaluated prior to the introduction of VTE risk screening forms (March 2022). Efficacy of the new VTE risk screening forms was also assessed (April 2023). Patient discharge summaries and patient medical records including medication charts were used to review the documentation of VTE risk assessments and details of thromboprophylaxis prescribing. Of 74 postnatal patients, 37.8% had VTE risk assessment documented prior to the introduction of VTE risk screening forms. Of 37 patients identified to be at moderate to high risk of VTE requiring pharmacological prophylaxis, 70.3% (n = 26) were appropriately prescribed pharmacological prophylaxis. After the risk screening forms were introduced, a total of 67 antenatal, postnatal, and gynecologic patients were studied. Of these, 32.8% (n = 22) of patients had all required fields completed appropriately. When using the forms, 26.9% (n = 7) of postnatal and 88% (n = 22) of gynecological patients were rated as medium or high risk, and all received medical review within 24 hours. Pharmacological prophylaxis was indicated in 88% (n = 22) of gynecological, 43.8% (n = 7) of antenatal, and 38.5% (n = 10) of postnatal patients, and all were appropriately prescribed. The guideline review and introduction of VTE risk screening forms was valuable to provide guidance in the risk assessment for VTE and to identify patients requiring prophylaxis.
开发静脉血栓栓塞症(VTE)风险筛查表的目的是记录已确定的 VTE 风险因素,包括血栓性疾病、VTE 病史、产后出血和剖宫产,并记录为降低这些风险和减少 VTE 并发症而采取的具体措施。 在引入 VTE 风险筛查表(2022 年 3 月)之前,对医院在评估 VTE 风险和适当开具血栓预防处方方面的指南合规性进行了评估。同时还评估了新的 VTE 风险筛查表的有效性(2023 年 4 月)。使用患者出院摘要和患者病历(包括用药记录)来审查 VTE 风险评估文件和血栓预防处方的详细信息。 在 74 名产后患者中,37.8% 的患者在引入 VTE 风险筛查表之前进行了 VTE 风险评估。在 37 名被确定为需要药物预防的中度至高度 VTE 风险的患者中,70.3%(n = 26)的患者得到了适当的药物预防处方。引入风险筛查表后,共对 67 名产前、产后和妇科患者进行了研究。其中,32.8%(22 人)的患者正确填写了所有必填项。在使用表格时,26.9%(n = 7)的产后患者和 88%(n = 22)的妇科患者被评为中度或高度风险,并且所有患者都在 24 小时内接受了医疗审查。88%(n = 22)的妇科患者、43.8%(n = 7)的产前患者和 38.5%(n = 10)的产后患者需要药物预防,并且所有患者都得到了适当的处方。 指南审查和引入 VTE 风险筛查表对于指导 VTE 风险评估和识别需要预防的患者很有价值。
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引用次数: 0
Adherence to Infection Prevention Practice Standard Protocol and Associated Factors Among Healthcare Workers. 医护人员对《预防感染操作标准协议》的遵守情况及相关因素。
Pub Date : 2024-05-02 eCollection Date: 2024-05-01 DOI: 10.36401/JQSH-23-14
Getachew Ossabo Babore, Yaregal Eyesu, Daniel Mengistu, Sisay Foga, Asnakech Zekiwos Heliso, Taye Mezgebu Ashine

Introduction: Healthcare-associated infection affects more than 100 million patients annually. Healthcare workers' poor adherence to standard infection prevention and control procedures can result in many negative consequences, ranging from disability to death.

Methods: A facility-based, cross-sectional study was conducted in June 2021 among 379 healthcare workers selected using a stratified random sampling technique. All types of healthcare providers except pharmacy professionals were included in the study. Standardization and validation of the study tool were performed ahead of data collection. Multivariable regression was used to assess the variables associated with adherence.

Results: The study found that 60.2% of healthcare workers (95% CI, 55.1-65.2) had good adherence to infection prevention practices, and 68.7% and good knowledge of infection prevention practices. Training on infection prevention methods (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.04-2.72), availability of water supply at hand washing station (AOR = 2.90; 95% CI, 1.62-5.31), and attitude toward infection prevention (AOR = 2.64; 95% CI, 1.65-4.24) were identified as predictors of adherence to infection prevention and control procedures.

Conclusion: More than half of the participants had good adherence to infection prevention guideline practices. In-service infection prevention training, a consistent water supply at the hand washing station, and a positive attitude of participants were associated with good adherence to infection prevention practices.

导言:每年有 1 亿多病人受到医疗相关感染的影响。医护人员不严格遵守标准的感染预防和控制程序会导致许多负面后果,从残疾到死亡不等:2021 年 6 月,我们采用分层随机抽样技术,对 379 名医护人员进行了一项基于医疗机构的横断面研究。除药学专业人员外,所有类型的医护人员均被纳入研究范围。在收集数据之前,对研究工具进行了标准化和验证。研究采用多变量回归法评估与依从性相关的变量:研究发现,60.2% 的医护人员(95% CI,55.1-65.2)对感染预防措施有良好的依从性,68.7% 的医护人员对感染预防措施有良好的了解。感染预防方法培训(调整赔率[AOR] = 1.68;95% CI,1.04-2.72)、洗手台供水(AOR = 2.90;95% CI,1.62-5.31)和对感染预防的态度(AOR = 2.64;95% CI,1.65-4.24)被认为是感染预防和控制程序依从性的预测因素:结论:一半以上的参与者都能很好地遵守感染预防指南的做法。在职感染预防培训、洗手站的持续供水以及参与者的积极态度都与良好遵守感染预防措施有关。
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引用次数: 0
Achieving Sustainability of Quality Improvement Projects. 实现质素改善计划的可持续性。
Pub Date : 2024-04-30 eCollection Date: 2025-02-01 DOI: 10.36401/JQSH-23-48
Augustine Kumah, Hillary Selassi Nutakor, Abdul-Razak Issah, Emmanuel Obot, Lawrencia Antoinette Aidoo, Jerry Selase Sifa, Shelter Agbeko Bobie
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引用次数: 0
Factors Affecting Pregnancy Complications in Ghana 影响加纳妊娠并发症的因素
Pub Date : 2024-04-23 DOI: 10.36401/jqsh-23-28
Yaw K. Wiafe, Andrews Asamoah, P. Akweongo, Augustine Kumah
The prevalence of maternal mortality continues to be a significant health concern across the world. In Ghana, pregnancy-related complications in the previous 5 years account for 12% of all deaths among women 15 to 49 years. More than half of these deaths were avoidable if early assessment had been done. However, assessment of the pooled prevalence of pregnancy-related complications among pregnant women to inform policy is limited. This study sought to determine the factors contributing to pregnancy complications in Ghana. Methods: Using a systematic sampling technique, a facility-based cross-sectional study was conducted among 415 pregnant women who attended antenatal care (ANC) services at Mamprobi Hospital. Bivariate and multiple logistics regression analyses were conducted to test significant factors determining pregnancy complications. The results of regression analysis are reported in odds ratio. Statistical significance was set at p < 0.05. Results: The mean age of the participants was 31.6 ± 6.6 years. The incidence of pregnancy complications among the pregnant women was 51.8% (95% CI, 0.47–0.56) The incidence of pregnancy complications among the women was significantly determined by age (adjusted odds ratio [AOR], 6.1; CI, 1.19–30.76), record of pregnancy complication (AOR, 2.5; CI, 1.35–4.49), ANC visit (AOR, 6.1; CI, 2.14–17.70), and family history of pregnancy complication (AOR, 3.6; CI, 1.25–10.40). Other significant factors included a record of abortion (AOR, 7.8; CI, 4.21–14.32), knowledge about obstetric danger signs (AOR, 2.4; CI, 1.21–4.88), and experiencing at least one obstetric danger sign during pregnancy (AOR, 6.6; CI, 3.30–13.29). Conclusion: The incidence of pregnancy complications was comparatively high among the women who used ANC services at Mamprobi Hospital. Early initiation of ANC services for pregnant women is an essential tool for addressing some of the challenges of early onset of some pregnancy complications, including anemia in pregnancy and preeclampsia. Midwives and other health workers who engage pregnant women should encourage their clients to initiate ANC visits at an early stage.
孕产妇死亡率仍然是全世界关注的一个重大健康问题。在加纳,15 至 49 岁妇女的所有死亡病例中,有 12% 是在过去 5 年中死于与妊娠有关的并发症。如果及早进行评估,其中一半以上的死亡是可以避免的。然而,对孕妇妊娠相关并发症的总体发病率进行评估,以便为制定政策提供依据的工作十分有限。本研究旨在确定导致加纳妊娠并发症的因素。研究方法采用系统抽样技术,对在 Mamprobi 医院接受产前保健(ANC)服务的 415 名孕妇进行了基于设施的横断面研究。对决定妊娠并发症的重要因素进行了二元和多元物流回归分析。回归分析的结果以几率比来报告。统计显著性以 p < 0.05 为标准。结果参与者的平均年龄为(31.6 ± 6.6)岁。孕妇妊娠并发症的发生率为 51.8% (95% CI, 0.47-0.56) 孕妇妊娠并发症的发生率显著取决于年龄(调整后的几率比 [AOR],6.1;CI,1.19-30.76)、妊娠并发症记录(AOR,2.5;CI,1.35-4.49)、产前检查(AOR,6.1;CI,2.14-17.70)和妊娠并发症家族史(AOR,3.6;CI,1.25-10.40)。其他重要因素包括流产记录(AOR,7.8;CI,4.21-14.32)、对产科危险征兆的了解(AOR,2.4;CI,1.21-4.88)以及孕期至少经历过一次产科危险征兆(AOR,6.6;CI,3.30-13.29)。结论在使用过曼普罗比医院产前保健服务的妇女中,妊娠并发症的发生率相对较高。尽早为孕妇提供产前检查服务是应对某些妊娠并发症(包括妊娠贫血和子痫前期)早期发病挑战的重要手段。助产士和其他为孕妇提供服务的卫生工作者应鼓励她们的客户尽早开始产前检查。
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引用次数: 0
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Global journal on quality and safety in healthcare
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