International Journal for Quality in Health Care最新文献

{"title":"Prevalence and contributing factors of intravenous medication administration errors in emergency departments: a prospective observational study.","authors":"Shirlyn Tan, Lih Jiuan Teh, Safura Mohd Mokhtaruddin, Josephine Henry Basil","doi":"10.1093/intqhc/mzaf012","DOIUrl":"10.1093/intqhc/mzaf012","url":null,"abstract":"<p><strong>Background: </strong>Medication administration in busy emergency departments (EDs) presents significant challenges due to the high-pressure environment and complexity of processes. Medication administration errors (MAEs) are a critical concern as they can severely impact patient safety and increase healthcare costs. Understanding the prevalence and underlying factors contributing to intravenous MAEs is essential for enhancing patient care and improving hospital services. This study aims to explore and measure the frequency of intravenous MAEs in EDs and identify factors contributing to these errors during their preparation and administration.</p><p><strong>Methods: </strong>This prospective study utilized the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration, and other procedures was recorded. Error rates were calculated, and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.</p><p><strong>Results: </strong>MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%), and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Nonverbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience, and high-alert medications showed no significant associations.</p><p><strong>Conclusion: </strong>The study highlighted a high prevalence of intravenous MAEs in EDs. Nonverbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programmes, strict enforcement of existing guidelines and protocols through regular audits, establishing nonpunitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and de-implementation of fecal occult blood tests in the acute care setting: a systematic review and meta-analysis.","authors":"Rebekah O Russell, Alejandro C Arroliga, Nanette L Myers, Gerald O Ogola, Tresa M McNeal, Niket Sonpal, Christian Cable, Valerie Danesh","doi":"10.1093/intqhc/mzae102","DOIUrl":"10.1093/intqhc/mzae102","url":null,"abstract":"<p><strong>Background: </strong>To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice.</p><p><strong>Methods: </strong>We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria.</p><p><strong>Results: </strong>Of 2471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n = 7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders.</p><p><strong>Conclusion: </strong>Overall, all studies endorse that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and validating a Global Trigger Tool for assessing frequency, level of harm, and preventability of adverse drug events in pediatric inpatients units.","authors":"Amit Gutkind, Amos Toren, Raz Somech, Yael Bezalel, Ronen Loebstein, Yair Edden, Bernice Oberman, Eyal Zimlichman","doi":"10.1093/intqhc/mzaf015","DOIUrl":"10.1093/intqhc/mzaf015","url":null,"abstract":"<p><strong>Background: </strong>Medications are a major cause of harm to patients in hospitals, and several studies have found that they cause approximately 20% of injuries that occur in medical institutions. It was found that the rate of adverse drug events (ADEs) in pediatric hospitalizations ranges from 11 to 40 events per 100 hospitalizations and 1% of cases caused death.</p><p><strong>Objectives: </strong>This is a comparative and retrospective study. The overarching objective is to adapt the Pediatric Trigger Tool (PTT) of the \"Child Health Corporation of America\" to pediatric wards in Israel, with the intention of using it to assess the rate of adverse events that occur during medication given in pediatric wards. The study characterized ADEs and examined the ability of the PTT to identify ADEs in relation to those that were voluntarily reported by the staff.</p><p><strong>Method: </strong>This study included internal and surgical pediatric wards at an academic pediatric medical center. The PTT was validated on medical record data from 700 hospitalizations between the years 2015 and 2017. The study also determined, among other things: the stage of drug administration at which the events occurred, the percentage of all events that could have been prevented, the degrees of damage the ADE caused and more.</p><p><strong>Results: </strong>The Positive Predictive Value of the customized tool stands at 16.91%. The study found 108 ADEs in 78 hospitalizations. The ADE rate per 100 hospitalizations was 15.4, the ADE rate per 1000 drug doses was 3.9, and the ADE rate per 1000 hospitalization days was 22.8, of which 18.5% were preventable. The category of drugs that led to the highest number of ADEs was painkillers. Those ADEs led to a large number of adverse clinical effects: constipation, hypokalemia, vomiting, and rash. The most common reason for coming to the hospital was suspicion or treatment of a hematologic disease, followed by hospitalization due to a burn. The customized tool found 10.8 times more ADEs than those reported voluntarily-subjectively by the clinical staff.</p><p><strong>Conclusions: </strong>The study found that, properly adapted, the PTT tool can be used to detect ADEs in internal and surgical pediatric wards.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"What matters to you?\": a powerful question to unlocking partnership in care.","authors":"Anthony Staines, Lisa Laroussi-Libeault, Veronica Coelho, Marie-Pascale Pomey","doi":"10.1093/intqhc/mzaf007","DOIUrl":"10.1093/intqhc/mzaf007","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing quality management in the medical devices industry: strategies for effective ISO 13485 implementation.","authors":"Diego Augusto de Jesus Pacheco, Samuel Vinícius Bonato, William Linck","doi":"10.1093/intqhc/mzaf004","DOIUrl":"10.1093/intqhc/mzaf004","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of wireless geographic locating system to improve medical equipment utilization and medical quality.","authors":"Tien-Lin Huang, Yi-Fang Lei, Pa-Chun Wang","doi":"10.1093/intqhc/mzaf005","DOIUrl":"10.1093/intqhc/mzaf005","url":null,"abstract":"<p><p>Hospitals require continuous process optimization to ensure uninterrupted care. This study investigates the integration of Real-Time Locating Systems (RTLS) with logistics and dispatch management in a metropolitan hospital. The system, which tracks circulating beds and medical equipment, improves resource allocation, reduces inefficiencies, and enhances task distribution using wearable devices and big data analytics. Results showed a 20.9% reduction in delivery time, 86.8% faster equipment search, and 91.2% staff satisfaction with zero adverse event recurrence. The findings underscore RTLS's potential to enhance medical quality, efficiency, and patient safety through digital technology adoption.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety in Low and Middle-Income Countries (LMICs): How can we do better?","authors":"Anuradha Pichumani, Andrew Likaka, Ezequiel García-Elorrio, Viviana E Rodriguez","doi":"10.1093/intqhc/mzaf006","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf006","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.","authors":"Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths","doi":"10.1093/intqhc/mzae120","DOIUrl":"10.1093/intqhc/mzae120","url":null,"abstract":"<p><strong>Background: </strong>Despite an epidemic of end-stage kidney disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to a successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: (i) design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment, (ii) provide transplant suitability assessments for all patients of the service, (iii) describe what temporary contraindications to kidney transplantation should be the focus of health service improvements, (iv) explore participant experiences with the suitability assessment process, and (v) use our findings to inform pre- and post-transplant model of care development within Kimberley Renal Services.</p><p><strong>Methods: </strong>Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis and semi-structured interview with thematic analysis.</p><p><strong>Results: </strong>Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and nonmedical contraindications, 5/46 had medical contraindications only, and 24/46 had nonmedical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46), and high body mass index (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.</p><p><strong>Conclusions: </strong>In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people, we achieved substantial catch-up in suitability assessments and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case management in emergency care: impact evaluation of the CARED Program.","authors":"Colin Eng Choon Ong, Joanne Yan Ting Yap, Kamala Velu, Christine Xia Wu, Adrian Ujin Yap, Kai Xin Ng, Michael Yat Sen Chu, Yock Young Dan, Peng Hui Choa, Phillip Hin Choi Phan","doi":"10.1093/intqhc/mzaf003","DOIUrl":"10.1093/intqhc/mzaf003","url":null,"abstract":"<p><strong>Background: </strong>Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.</p><p><strong>Methods: </strong>A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.</p><p><strong>Results: </strong>Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71-5.23%) and 60-day (6.69%; 95% CI 5.47-7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83-5.95%) and 60-day (6.50%; 95% CI 5.28-7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; P = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; P = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; P = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; P = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; P = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; P = .011, respectively).</p><p><strong>Conclusion: </strong>CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case management in emergency care: impact evaluation of the CARED Program.","authors":"Colin Eng Choon Ong, Joanne Yan Ting Yap, Kamala Velu, Christine Xia Wu, Adrian Ujin Yap, Kai Xin Ng, Michael Yat Sen Chu, Yock Young Dan, Peng Hui Choa, Phillip Hin Choi Phan","doi":"10.1093/intqhc/mzaf003","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf003","url":null,"abstract":"<p><strong>Background: </strong>Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.</p><p><strong>Methods: </strong>A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.</p><p><strong>Results: </strong>Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71-5.23%) and 60-day (6.69%; 95% CI 5.47-7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83-5.95%) and 60-day (6.50%; 95% CI 5.28-7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; P = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; P = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; P = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; P = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; P = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; P = .011, respectively).</p><p><strong>Conclusion: </strong>CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}