Tesis sobre el tema "Medical error"
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1
Greig, Paul. "Perceptual error in medical practice". Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:bea354bf-7c2f-44da-a24f-83a2df804b69.
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Introduction: Medical errors are major hazards, and lapses in non-technical skills such as situational awareness contribute to most incidents. Risks are concentrated in acute care, and in crisis situations clinicians can apparently ignore vital information. Poor workplace ergonomics contributes to risk. Existing work into perceptual errors offers insights, but these phenomena have been little researched in medicine. This thesis considers medical non-technical skills and how they are taught, and explores vulnerability to inattentional and change blindness. Methods: Medical human factors and the psychology of perceptual error were reviewed, and a mixed-methods assessment of postgraduate medical curricula completed. Experiments assessed clinicians' interaction with clinical monitoring devices using eye-tracking, and studies were conducted exposing clinicians to various perceptual error stimuli using non-clinical and clinical videos, and simulation. A survey was also conducted to assess clinicians' insight into the phenomena of perceptual error. Results: Non-technical skills feature poorly in medical curricula, and equipment is poorly standardised in critical care areas. Unfamiliar devices slow response times and increase error rate. Clinical training confers no generalisable advantage in perceptual reliability. Even expert clinicians miss important events. Two out of every three life-support instructors for example missed a critical failure in the patient's oxygen supply when watching a recorded emergency simulation. The insight and understanding healthcare staff have of perceptual errors is poor, leading to significant overestimates of perceptual reliability that could have consequences for clinical practice. Conclusions: Perceptual errors represent a latent risk factor contributing to loss of situational awareness. High rates of perceptual error were observed in the video-based experiment. Although lower rates were observed in simulation, important events were still missed by participants that could have serious consequences. The incidence of perceptual error appears sensitive to the method used to test for it, and this has important implications for the design of future experiments testing for these phenomena. Mitigating perceptual error is likely to be challenging, but relatively simple adjustments to team practices in emergency situations may be fruitful.
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Biquet, Jean-Marc. "Patient safety in medical humanitarian action : medical error prevention and management". Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE1038.
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La sécurité des patients est reconnue depuis une vingtaine comme un des éléments essentiels de la qualité des soins et est devenu une partie intégrante des systèmes de santé. Elle se déclinée en règlementations, outils et stratégies qui touchent tous les secteurs de la médecine. Aujourd’hui les recherches et applications de la sécurité des patients concernent surtout les systèmes de santé des pays les plus développés alors même que deux-tiers des incidents de sécurité estimés se produisent dans les pays à revenu faible ou moyen. Une phase exploratoire a permis de confirmer que la sécurité du patient et la détection et gestion des erreurs médicales n’ont pas encore eu de traduction structurée, adaptée au secteur de l’aide médicale humanitaire. Afin d’essayer de comprendre les raisons de ce décalage, cette thèse s’intéresse au statut actuel et aux perspectives de la sécurité des patients dans l'action médicale humanitaire. Une première partie se penche sur les développements dans les sciences de la sécurité et de la gestion des risques et aborde l’état de connaissance actuelle et les principaux développements en matière de sécurité des patients, et de la gestion des erreurs médicales en particulier. Suit une analyse des caractéristiques de l’action médicale telle que déployée par les organisations médicales.La deuxième phase de la thèse se centre sur des entretiens semi-directifs avec du personnel médical et paramédical actifs au sein de 6 organisations médicales humanitaires pour connaître l’état actuel des développements en matière de sécurité du patient et de la gestion des erreurs médicales. 39 entretiens ont été menés avec du personnel international médical ou paramédical ayant 2 ans d’expérience minimum dans le secteur humanitaire pour comprendre leurs connaissances, attitudes et attentes en matière de sécurité du patient et de la gestion des erreurs médicales dans leur secteur.Il apparait clairement que s’il n’existe actuellement pas encore dans le secteur d’approche structurée de la question de la sécurité du patient et plus spécifiquement de la gestion des erreurs médicales, cela répond clairement à une attente de la part du personnel humanitaire interviewé. Les raisons invoquées pour expliquer ce manque sont de deux ordres. Il y a celles en lien avec les spécificités de l’action médicale humanitaire et celles que l’on a pu retrouver dans les systèmes de santé des pays de l’OCDE.Cette recherche, la première du genre selon nos informations, identifie la motivation du personnel médical et paramédical du secteur humanitaire à s’engager à mener une véritable révolution culturelle pour rendre l’offre de soins plus sûre, même dans des situations précairesPatient safety is recognized for some 20 years as one of the essential elements of healthcare quality and has become an integral part of healthcare systems. It encompasses regulations, tools and strategies that affect all sectors of medicine. Today, research and implementation in the area of patient safety pertain above all to healthcare systems in the most developed countries whereas two thirds of estimated safety incidents occur in low- or mid-income countries.An exploratory phase aiming at developing the research strategy confirmed that patient safety, per se, and the detection and management of medical errors have not yet been translated into the humanitarian assistance sector in a structured and adapted way. In order to understand the reasons for this gap this thesis aims to understand what the current status and perspectives of patient safety in medical humanitarian action are. An initial phase explored developments in the knowledge of safety and risk management and the current state of knowledge and the main developments in patient safety and especially medical error management were explored. Follows an analysis of the characteristics of medical action as carried out by medical humanitarian organisations.The second part of the thesis is centred on semi-directive discussions with medical and paramedical personnel active within six medical humanitarian organisations to understand the knowledge, attitudes and practises with regards to patient safety and medical error management. 39 interviews were done with international medical and paramedical staff with minimum 2 years of experience in the humanitarian sector. It appears clearly that, while there may not yet be a structured approach in the sector regarding patient safety and, specifically, medical error management, this clearly corresponds to an expectation on the part of the humanitarian personnel interviewed.This research, to our knowledge the first of its kind, demonstrates the eagerness of the medical and paramedical staff engaged in humanitarian action to commit to an internal cultural revolution towards a safer healthcare provision, even in precarious situations. Catching up the delays in adopting adapted patient safety and medical error management policies would reinforce the accountability to the vulnerable populations assisted by these organisations and save more lives, the essence of humanitarian purpose
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Ly, Huong Q. "Medical Laboratory Managers Success with Preanalytical Errors". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3498.
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Clinicians rely heavily on accurate laboratory results to diagnose and treat their patients. Laboratory errors can occur in any area of total testing phases, but more than half of the errors occur in the preanalytical phase. Framed by the total quality management theory, the purpose of this multiple case study was to explore medical laboratory managers' strategies to reduce preanalytical errors. A purposive sample of 2 organizations with laboratories in southern California participated in semistructured face-to-face interviews. Company A had 2 participants and 3 participants participated in the study from Company B. Each participant had at least 5 years of laboratory experience, with a minimum of 2 years of management experience in preanalytical testing, and had completed one project to minimize laboratory errors. Thematic analysis exposed 5 main themes: quality improvement, recognition, reward, and empowerment, education and training, communication, and patient satisfaction. The participants highlighted the need for organizations to concentrate on quality management to achieve patient satisfaction. To achieve quality services, medical laboratory managers noted the importance of employee engagement, education and training, and communication as successful strategies to mitigate preanalytical errors. The recommendation for action is for laboratory leaders to review and apply effective strategies exposed by the data in this study to reduce preanalytical errors in their medical laboratory. Positive implications of this study include reduction of preanalytical errors, increased operational cost, and improved patient experience.
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Anderson, Oliver. "Designing Out Medical Error (DOME) in surgical wards". Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/55113.
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Background One in ten hospital patients are unintentionally harmed by their healthcare management. Healthcare professionals are often blamed for making mistakes that could be prevented if all the factors influencing human performance were addressed by designing the system to be safer. Hypothesis This thesis is part of the Designing Out Medical Error (DOME) project, which tested the hypothesis that a multidisciplinary team of designers, clinicians, psychologists and business analysts working collaboratively could design interventions to improve patient safety in surgical wards. Methods & Results We used a combination of observational techniques including Healthcare Failure Mode and Effects Analysis to proactively assess risk in surgical wards. We focused on five high-risk processes: hand hygiene, isolation of healthcare-associated infection, vital signs monitoring, handover communication and medication delivery. Patients and healthcare professionals were involved at every stage and helped co-design a suite of concepts to address risk in these processes. We progressed two prototypes: the Respiratory Rate Recorder and the CareCentre® (a bedside work table containing equipment including alcohol hand-rub) to simulated and clinical trials. The trials demonstrated that the accuracy of manual respiratory rate measurement and the adherence of healthcare workers to hand hygiene guidelines was significantly improved respectively, thus supporting the hypothesis. Conclusion Multidisciplinary collaborations that engage with the teams, processes and equipment of the healthcare system can co-design safer interventions. Better design can influence behaviour and improve the performance of healthcare professionals. The DOME project demonstrates a successful method for others to follow.
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Sirriyeh, Reema Hussein. "Coping with medical error : the case of the health professional". Thesis, University of Leeds, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.555843.
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Many errors do not lead to adverse consequences for patients, but all errors can have a devastating impact on the health professional that has made the mistake; they are described as the 'second victim' (Wears & Wu, 2000; Wu, 2000). Errors often lead to professional and personal distress, which has implications for the quality and safety of patient care. This thesis explores the impact of making a medical error on the health professional and the strategies used to cope. The objectives of this work are to a) understand health professional's response, b) increase the evidence base about coping with this experience, and c) identify strategies to support health professionals recover. A mixed methods approach was engaged to achieve the research goals. A sequence of studies were developed based on a systematic review of the literature, and further informed by findings at each stage of the research. Studies one and two employed a cross-sectional survey in the UK and then the US to gather a diversity of data regarding responses to error, common experiences, coping strategies, and facilitators and barriers in recovery. Study three used semi-structured interviews with health care managers to explore the context of error, and gather further knowledge of the role of the manager, which was highlighted as significant in studies one and two. Following a brief review of existing attempts to support staff after error, the [mal study used focus group work with multi-disciplinary groups of health professionals to explore support and coping. Empirical data was generated, illustrating the profound impact of making a medical mistake, and the challenges of recovery. The importance of coping strategy selection in recovery from error was established as a crucial area for exploration. The value of peers and managers in the provision of support, and the importance of embedding support in the workplace were also recognised. The thesis concludes that the impact of making a medical error on health professionals is complex, and a multitude of factors can be influential in their experiences. Offering appropriate support is a continuing challenge, but one that is important to address. Undertaking this sensitive, applied research was challenging, but some lessons in developing such work have been learnt which may be applied in future undertakings.
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Volkerding, Jill. "Nursing Students' Perceptions and Barriers Related to Medical Error Reporting". Thesis, Carlow University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10027559.
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This paper evaluates nursing students’ perceptions and barriers as related to medical error reporting. This study was conducted as a mixed method based on the PS-ASK survey tool designed by Schnall et al (2008). Medical errors are a large problem in healthcare institutions. Understanding the underlying causes of why these events occur is needed in order to prevent repeat occurrences of the same error. However, in order to fully understand the underlying cause of the error, first and foremost, it must be reported. Evaluating nursing students’ perceptions and barriers to utilization of an error reporting system and addressing these issues is a crucial step towards decreasing medical error and improving patient safety. This study found that nursing students have an overall positive attitude toward error reporting. This survey validated the need for instituting a just culture within nursing education, in order to help encourage error reporting, rather than discourage it. Practice changes should be made in nursing education to provide transparency and role modeling with error reporting in order to encourage student accountability for reporting errors.
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Quick, Oliver. "Error and the medical profession? : regulating trust. The end of professional dominance?" Thesis, Cardiff University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490275.
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Queiruga, Caryn y Rebecca Roush. "Medication Error Identification Rates of Pharmacy, Medical, and Nursing Students: A Simulation". The University of Arizona, 2009. http://hdl.handle.net/10150/623966.
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Class of 2009 AbstractOBJECTIVES: To assess the ability of pharmacy, medicine, and nursing students to identify prescribing errors METHODS: Pharmacy, medicine, and nursing students from the University of Arizona were asked to participate in this prospective, descriptive study. Pharmacy and medical students in the last didactic year of their program and traditional bachelor of nursing students in the fourth semester of their program were eligible to participate. Subjects were asked to assess a questionnaire containing three sample prescriptions, evaluate if each was correct and indicate the type of error found, if any. The primary outcome measure was the number of correctly identified prescribing errors. The secondary outcome measure was the number of correct types of error found. Error identification rates for each group were calculated. Comparisons in these rates were made between pharmacy, medicine and nursing students. Chi square tests were used to analyze the nominal data gathered from various groups. RESULTS: Pharmacy students were significantly better able to identify errors than medical and nursing students (p<0.001). Pharmacy students were significantly better able to determine the type of error (p<0.001). CONCLUSIONS: Overall, pharmacy students had higher prescribing error identification rates than medical and nursing students. More studies need to be done to determine the most appropriate way to increase prescribing error identification rates.
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Denny, Diane. "Medical Error Reporting and Patient Safety: An Exploration of Our Underreporting Dilemma". Diss., Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/427730.
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Business Administration/InterdisciplinaryPh.D.
Studies suggest that the majority of hospital errors go unreported. Equally disturbing is that data surrounding near miss events that could have harmed patients has been found to be even sparser. At the core of any medical error reporting effort is a desire to obtain data that can be used to reduce the frequency of errors, reveal the cause of errors, and empower those involved in the healthcare delivery system with the insight required to design methods to prevent the flaws that allow mistakes to occur. Aligned with the adage that “we can’t fix what we don’t know is broke”, the question is raised why does underreporting exist? The likelihood of reporting medical errors is explored as a manifestation of culture. Factors studied include communication and feedback, teamwork, fear of retribution, and leadership support (top management and supervisor). Data is presented using a nationally recognized instrument—the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey. Findings from the research are mixed with little positive relationship between the model and number of events reported although each factor is found to be positively associated with an employee’s perceived frequency by which near miss and no harm events are reported. While advances in patient safety have materialized, the act of employees’ actually reporting events still pales in comparison to the number of errors that have likely occurred, regardless of efforts to advance culture. To explore influencers beyond those found in the AHRQ Culture of Safety survey, an overlapping model is presented. This includes studying various underlying factors, such as understanding what constitutes a reportable event, ease of reporting, and knowledge of the processes supporting data submission, along with attempting to better assess the impact of the direct supervisor and incentives in influencing behavior. Findings suggest that these additional factors do contribute, albeit modestly, to the act of reporting errors. When adding tenure and patient interaction to the model, a higher percentage of the variance is explained. In terms of perceived frequency of reporting near misses and no harm events, this model yields similar results to the first, explaining approximately 28% of the variance. The two factors most positively associated with perceived frequency of reporting near miss and no harm events are communication and feedback and infrastructure —suggesting that some unexplored relationship may exist between the overlapping models.
Temple University--Theses
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Wang, Xiaofeng. "New Procedures for Data Mining and Measurement Error Models with Medical Imaging Applications". Case Western Reserve University School of Graduate Studies / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=case1121447716.
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Moliani, Maria Marce. "O reverso da cura = erro médico". [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/281018.
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Orientador: Thomas Patrick DwyerTese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas
Made available in DSpace on 2018-08-17T03:36:02Z (GMT). No. of bitstreams: 1 Moliani_MariaMarce_D.pdf: 2474438 bytes, checksum: 21f53ff10257b2a7c6a4b32eebec64f0 (MD5) Previous issue date: 2010
Resumo: O objetivo desta tese é analisar as causas de erros médicos junto aos profissionais de saúde e os pacientes, vitimas de erros médicos a fim de compreender os condicionantes sociais dos erros e efeitos adversos do processo de tratamento medico, verificando a influência de fatores tais como: os condicionantes profissionais, através da identidade do sujeito social com a profissão e com os papéis sociais desempenhados; formação medica e condições de trabalho. Esse trabalho utilizou como referencial Teórico-metodológico aportes da fenomenologia de Alfred Schutz, a fim de compreender os critérios de relevância mobilizados pelo sujeito social no curso de sua ação. A pesquisa foi elaborada utilizando metodologia qualitativa, através de entrevistas e apreensão dos condicionantes da ação
Abstract: The aim of this thesis is to analyze the causes of medical errors, involving health professionals and patients, the victims of medical errors, in order to understand the social conditions of the errors, as well as the adverse effects of the medical treatment process, checking the influence of factors such as: professional conditions, through the social subject's identity in the profession and the social roles played, as well as medical training and work conditions. This work was based on the theoretical and methodological contributions of Alfred Schutz's phenomenology, in order to understand the relevance criteria raised by the social subject in the course of action. The methodology used in the research was qualitative, through interviews and by understanding the action determinants
Doutorado
Doutor em Ciências Sociais
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Amaral, Fernanda Regina da Cunha. "Responsabilidade dos hospitais e operadoras de saúde pelos danos causados aos pacientes". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/2/2136/tde-22042013-143114/.
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Esta dissertação trata da responsabilidade médica decorrente dos danos causados aos pacientes. A questão central do trabalho refere-se a investigar as reais causas para a ocorrência do erro médico que acarreta na geração do dano indenizável. A razão que determinou o interesse pelo estudo da responsabilidade médica foi a constatação nos últimos anos do aumento significativo de demandas judiciais ajuizadas em face dos profissionais da medicina sob alegação de erro médico causador de um dano. Partimos do pressuposto de que os erros médicos muitas vezes ocorrem não por culpa exclusiva do médico que prestou o atendimento, mas sim por outras causas que fogem do controle do médico, tais como a culpa dos hospitais, das operadoras de saúde, do próprio paciente que não seguiu as recomendações médicas, ou até mesmo do Estado, pela falta de investimentos na saúde. Por fim, o trabalho analisa a responsabilidade das operadoras de saúde, dos hospitais e do Estado nas demandas judiciais indenizatórias propostas pelos pacientes.This thesis will study the medical responsibility regarding the damage caused to the patients. Investigating the real causes of medical errors which lead to compensable damage will be the main purpose of this study. The reason for the interest in the analysis of the medical responsibility is the significant increase in lawsuits filed in recent years against medical professionals alleging a detriment caused by a medical error. We can assume that the so called medical errors dont exclusively occur on account of the medical practitioner who attended the patient but as well very often because of third parts such as hospitals, health insurance companies, patients themselves who did not follow the medical recommendations or even the state through a lack of investment in health. Finally, the responsibility of the aforementioned in lawsuits filed by patients for damages, will be thoroughly analyzed.
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Lundberg, Molly. "Error Identification in Tourniquet Use : Error analysis of tourniquet use in trained and untrained populations". Thesis, Linköpings universitet, Institutionen för datavetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-171588.
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The number of prehospital deaths caused by large bleedings could be decreased if civilian people would act in time to help the injured patient. One way to help is to stop the bleeding with a tourniquet application. However, the tourniquet needs to be placed correctly in order to stop the bleeding. Therefore laypersons need to be educated in bleeding control to increase the rate of successful tourniquet application. This study used human error identification techniques such as Hierarchical Task Analysis and Systematic Human Error Reduction and Prediction Approach to identify possible errors of four commonly used tourniquet models: the CAT-7, Delfi-EMT, SAM-X and SWAT-T. The results show that many predicted errors are time-oriented and critical. Video analysis of tourniquet application was performed to map occurred use errors from the videos with the predicted ones. The goal was to identify problems that could be solved by training or redesigns of the tourniquets. The results show that the most common errors for all participants during tourniquet application were of six error types. The errors were to not check time or write down time of application, to take too much time to place the tourniquet around the limb, to place the tourniquet upside down, to place the tourniquet band over the securing mechanism instead of between and lastly to not secure the tourniquet correctly before transporting the patient. The untrained laypersons made more errors than the trained laypersons and professional emergency personnel group. The trained laypersons also made fewer errors in a calm setting than in a stressed setting, comparing to the professional group who did the same error types in both settings. The results indicate that untrained laypersons not only make more errors but also more critical errors than trained laypersons and professional emergency personnel. Future research should empirically test other tourniquet models than the CAT in the goal of finding use errors to be reduced. Overall the results are in line with previous studies that show the need for education of bleeding control techniques in the civilian population.
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McElvery, Raleigh. "Trial and Error : medical marijuana, the absence of evidence, and the allure of anecdote". Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/112883.
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Thesis: S.M. in Science Writing, Massachusetts Institute of Technology, Department of Comparative Media Studies/Writing, 2017.Cataloged from PDF version of thesis.
Includes bibliographical references.
For the past four years, Christy Shake has given her son marijuana extract six times a day to ease his childhood epilepsy. Hers is a compelling story that highlights the potential benefits of medical cannabis. But in the wake of antiquated and inflexible federal legislation, anecdotal reports like these are essentially all we have. More than half the states in the U.S. have voted to legalize medical marijuana, as thousands contend it's a viable treatment for a growing list of conditions. Nevertheless, as more and more patients gain access to cannabis, neither they nor their physicians understand exactly what they're receiving from local dispensaries. Patients, caregivers, scientists, physicians, pharmaceutical companies, and dispensary growers alike are calling for changes to government policies that restrict research. It's high time to separate politics from science.
by Raleigh McElvery.
S.M. in Science Writing
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Burke, Darlene M. "Enhancing the patient safety culture of ABSN students through instruction on medical error recovery". Thesis, Capella University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3610403.
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Attitudes toward patient safety are the foundation of patient safety culture. Nursing students begin to formulate their attitudes toward patient safety while in educational programs. Nursing faculty have been challenged in their efforts to enhance the patient safety culture of students because there is a lack of empirical evidence as to which teaching strategies positively affect student attitudes toward patient safety. The purpose of this study was to examine the relationship between a 50-minute teaching module based upon the concept of medical error recovery and 9 dimensions of patient safety culture as measured by the Attitudes to Patient Safety Questionnaire. The guiding framework for the study was the reciprocal interactive theory of patient safety culture in nursing. The conceptual model used to illuminate the role of nurses in recovering medical errors in the educational intervention was the modified Eindhoven model of near-miss events. The sample comprised 4 student cohorts (N = 142) enrolled in an accelerated bachelor of science in nursing (ABSN) program at one university, with 4 participants lost to follow-up (n = 138). A quasi-experimental, nonequivalent control group, pretest/posttest design was used to compare mean attitude scores between the control (n = 75) group and the intervention group (n = 63) after statistically controlling for the pretest. ANCOVA revealed statistically higher mean attitude scores for the intervention group in 5 of 9 dimensions of patient safety culture with a small-medium effect size associated with the intervention: patient safety training, error inevitability, professional incompetence as error cause, patient's role in error, and importance of patient safety culture in curriculum. The results supported the use of a short-duration educational session on medical error recovery to enhance a subset of patient safety culture dimensions among ABSN students.
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Ayres, Brennan S. "The role of teamwork in diagnosis: team diagnostic decision-making in the medical intensive care unit". Thesis, University of Iowa, 2017. https://ir.uiowa.edu/etd/5706.
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Diagnostic errors cause significant patient harm and occur among 15 percent of all clinical diagnoses, but research has yet to effectively target, prevent, and mitigate diagnostic errors from occurring. So far, literature has examined how diagnostician decision-makers perform and reach a clinical diagnosis individually. However, the impact of team-based activities on diagnosis is unknown. The purpose of this study is to describe provider perception on how providers come together as a team in order to complete a clinical diagnosis. As a qualitative descriptive study with overtones of grounded theory, 18 semi-structured interviews of medical intensive care unit providers were audio-recorded, transcribed, and coded generating themes of diagnostic teamwork structure and functioning. Diagnostic teams are described using themes of inter-professional and intra-professional teamwork among roles with and without diagnostic team identity. Novel approaches to diagnostic error research, practice implications for current providers, and applications provided for improving education and team training. By providing preliminary insights on the role of teamwork in diagnostic decision-making, this study may assist future studies that improve diagnostic teamwork and prevent diagnostic errors.
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Garcia, Nuno Augusto Pereira. "Erro médico estudo da responsabilidade civil dirigido ao profissional da saúde /". Botucatu, 2020. http://hdl.handle.net/11449/192233.
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Orientador: Daniele Cristina CataneoResumo: Introdução: Considerando que no Brasil, observou-se um crescimento exponencial das demandas judiciais relacionadas aos serviços prestados pelos profissionais da saúde, entende-se necessário um estudo aprofundado à respeito do erro médico com abordagem direta a esse profissional, carecedor de tratamento especial e protetivo sempre que, diante das falhas oriundas do seu exercício profissional, forem verificados fatores de imprevisibilidade capazes de comprometer a exitosa prestação do serviço ofertado. Necessária também, a abordagem no presente trabalho, das mudanças na relação entre o profissional da saúde e o paciente, as prerrogativas de facilitação do acesso ao judiciário, o atendimento aos protocolos clínicos preestabelecidos, dentre outras variáveis, sendo que tais pontos são relevantes para o crescente aumento das ações judiciais e, por consequência, a forma que as decisões são proferidas ao apreciar problemáticas dessa natureza. Objetivos: Descrever acerca da problemática do erro médico quando analisado sob a ótica da responsabilidade civil. Explorar a teoria da responsabilidade civil, a extensão das variáveis de responsabilidade, legislações pertinentes, além de comparar decisões proferidas no Brasil e em outros países. Metodologia: Fora realizada uma revisão da literatura existente sobre o tema e assim elaborada uma dissertação que reuniu e analisou doutrinas acerca do erro médico. Dentre os materiais que foram utilizados, estão as legislações nacionais e internaciona... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Considering that in Brazil, there has been an exponential increase in the legal demands related to the services provided by health professionals, it is necessary to conduct an in-depth study about medical error with a direct approach to this professional, who needs special and protective treatment, whenever, in the face of failures arising from their professional practice, unpredictable factors are verified that can compromise the successful provision of the service offered. It is also necessary, the approach in the present work, of the changes in the relationship between the health professional and the patient, the prerogatives of facilitating access to the judiciary, the attendance to the pre-established clinical protocols, among other variables, and such points are relevant to the increasing increase in lawsuits and, consequently, the way in which decisions are rendered when considering problems of this nature. Objectives: To describe the problem of medical error when analyzed from the perspective of civil liability. Explore the theory of civil liability, the extent of liability variables, relevant legislation, and compare decisions made in Brazil and other countries. Methodology: A review of the existing literature on the topic had been carried out and a dissertation was prepared, which brought together and analyzed doctrines about medical error. Among the materials that were used, there are national and international laws covering the theme and existing leg... (Complete abstract click electronic access below)
Mestre
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Cunningham, Thomas R. "A Behavioral Evaluation of the Transition to Electronic Prescribing in a Hospital Setting". Thesis, Virginia Tech, 2006. http://hdl.handle.net/10919/31873.
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The impact of Computerized Physician Order Entry (CPOE) on the dependent variables of medication-order compliance and time to first dose of antibiotic was investigated in this quasi-experimental study of a naturally-occurring CPOE intervention. The impact of CPOE on compliance and time to first dose was assessed by comparing measures of these variables from the intervention site and a non-equivalent control before and during intervention phases. Medication orders placed using CPOE were significantly more compliant than paper-based medication orders (p<.001), and first doses of antibiotic ordered using CPOE were delivered significantly faster than antibiotic orders placed using the paper-based system (p<.001). Findings support previous research indicating the positive impact of CPOE on patient safety as well as justify and enable future interventions to increase CPOE adoption and use among physicians. Additionally, data collected in this study will be used to provide behavior-based feedback to physicians as part of CPOE adoption and use intervention strategies to be explored in the forthcoming research.Master of Science
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Gorga, Maria Luiza. "Minimizando riscos - compliance penal para o profissional da medicina". Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/2/2136/tde-29072016-153138/.
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A presente dissertação busca aproximar o compliance penal ao cotidiano do profissional da medicina. Será analisada a possibilidade de o instituto, que tem por foco a pessoa jurídica, ser aplicado diretamente a pessoas físicas. As questões penais que envolvem a medicina também serão levantadas, com foco nos principais tipos penais que podem se apresentar no dia a dia do profissional. Será discutido se a adoção de normas de compliance consistiria uma assunção de culpa em caso de violação destas, e como esta implementação pode ser vista à luz da teoria da imputação objetiva. Estudaremos a teoria do erro de James Reason e os conceitos de Cultura Justa, ambos ferramentas que auxiliam na criação de normas preventivas. Forneceremos um delineamento geral dos elementos que devem, idealmente, compor o compliance para os profissionais da medicina. Analisaremos acórdãos do Tribunal de Justiça do Estado de São Paulo, com breve apontamentos acerca do atual panorama dos processos criminais que envolvem questões médicas. A conclusão busca responder se a adoção do compliance se justifica frente a todo o analisado, e se é benéfica para os profissionais.This work tries to approximate the criminal compliance to the medical professional\'s daily life. It analyses the possibility of applying the institute, which is focused on corporations, directly to individuals. Criminal issues involving the field of medicine will also be raised, focusing on main crimes that can arise on daily activities. We will discuss if the adoption of standards of compliance would be seem as an assumption of guilt in case of violations of those, and how this implementation can be seen in light of the Theory of Objective Imputation. We will study the errors theory of James Reason and the concepts of Just Culture, both tools that assist in the creation of preventive standards. We provide a general outline of the elements that should ideally comprise the compliance program to medical professionals. We will analyze decisions of the Court of Justice of the State of São Paulo, with brief notes about the current situation of litigations involving medical issues. The conclusion seeks to answer whether the adoption of compliance methods can be justified at all, and if it is beneficial for the professionals.
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Sarac, Cakil. "The Association Between Organizational Culture And Individual Factors On Medical Practice". Master's thesis, METU, 2007. http://etd.lib.metu.edu.tr/upload/12608501/index.pdf.
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The aim of the present research was to investigate the relationships between patient safety culture within hospitals and individual factors on medical practice among physicians. A total of 240 physicians from ten different hospitals completed the Medical Practice Questionnaire, Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and Eysenck Personality Questionnaire Revised- Abbreviated Form. In order to assess frequency and types of medical errors, Medical Practice Questionnaire was developed by the author. Factor analysis of this Questionnaire demonstrated the existence of four subscales named as Patient Management/Information Delivery Errors, Execution Errors, Procedure Related errors and One Source Errors. ANOVA results revealed that males conduct more Procedure Related Errors than females. In support of the hypothesis, a number of differences observed on patient safety culture between types of institutions that public hospitals received lower scores on most of the safety dimensions. Regression analysis results revealed that personality dimensions and burnout levels were significantly related to types and frequency of errors. Considering significant predictors, while the extravert participants were found to report more Patient Management/Information Delivery, Execution and Procedure Related errors,
Neurotics were found to report lower levels of errors on these three dimensions.
Regression analysis of burnout levels showed that depersonalization were also associated with these three error dimensions.The level of depersonalization were found to increase the frequency of Patient Management/Information Delivery, Execution and Procedure Related Errors. The research findings however, did not support the assertion in a manner that safety culture dimensions were not found to have main effects on types of errors. The limitations of the current research and implications for further research were discussed.
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Fabri, Peter J. "The validation of a methodology for assessing the impact of hybrid simulation training in the minimization of adverse outcomes in surgery". [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002085.
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Cunningham, Thomas Raymond. "A comprehensive approach to preventing errors in a hospital setting: Organizational behavior management and patient safety". Diss., Virginia Tech, 2009. http://hdl.handle.net/10919/26279.
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Estimates of the number of U.S. deaths each year resulting from medical errors range from 44,000 (Institute of Medicine, 1999) to 195,000 (HealthGrades, 2004). Additionally, instances of medical harm are estimated to occur at a rate of approximately 15 million per year in the U.S., or about 40,000 per day (Institute for Healthcare Improvement, 2007).
Although several organizational behavior management (OBM) intervention techniques have been used to improve particular behaviors related to patient safety, there remains a lack of patient-safety-focused behavioral interventions among healthcare workers. OBM interventions are often applied to needs already identified within an organization, and the means by which these needs are determined vary across applications. The current research addresses gaps in the literature by applying a broad needs-assessment methodology to identify patient-safety intervention targets in a hospital and then translating OBM intervention techniques to identify and improve the prevention potential of responses to reported medical errors.
A content analysis of 17 months of descriptions of follow-up actions to error reports for nine types of the most-frequently-occurring errors was conducted. Follow-up actions were coded according to a taxonomy of behavioral intervention components, with accompanying prevention scores based on criteria developed by Geller et al. (1990). Two error types were selected for intervention; based on the highest frequency of reporting and lowest average follow-up prevention score. Over a three-month intervention period, managers were instructed to respond to these two error types with active communication, group feedback, and positive reinforcement strategies.
Results indicate improved prevention potential as a consequence of improved corrective action for targeted errors. Future implications for identifying and classifying responses to medical error are discussed.Ph. D.
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Wheeler, Daniel Wren. "Weakened by strengths : drugs in solution, medication error and drug safety". Thesis, University of Oxford, 2008. http://ora.ox.ac.uk/objects/uuid:238087a5-120b-4a3d-9437-5840cecf8b6a.
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The concentrations of some drug solutions are often expressed as ratios or percentages. This system simplified prescription and dispensing when Imperial measures such as grains and minims were used. Ampoules of powerful vasoactive drugs such as catecholamines and potentially toxic local anaesthetics are still labelled as ratios and percentages, seemingly through habit or tradition than for any useful clinical reason. This thesis argues that adherence to this outdated system is confusing, causes drug administration errors, and puts patients at risk. Internet-based questionnaires were used to quantify medical students’ and doctors’ understanding of ratios and percentages. A substantial minority of almost 3000 doctors could not convert between ratios, percentages and mass concentration correctly, made dosing errors of up to three orders of magnitude in written clinical scenarios, and struggled with conversions between metric units. These findings are strong arguments for expressing drug concentrations as mass concentration and providing better drug administration teaching. High fidelity patient simulation was used to examine the influence of clearer ampoule labelling and intensive drug administration teaching. This allowed critical incidents to be reproduced realistically, clinical performances to be assessed, and outcome measures to be accurately recorded. Randomised controlled trials were conducted that demonstrated positive influences of both interventions for doctors and students. The difficulties that nurses encounter when preparing infusions of these drugs on critical care units were also studied and are reported. The findings presented should be sufficient to persuade regulatory authorities to remove ratios and percentages from ampoule labels – a straightforward, cheap, commonsense intervention. The lack of effective clinical error reporting systems and the extreme practical difficulties of conducting clinical trials in this field mean that a firm link between this intervention and patient outcome is unlikely ever to be made, but this should not be an excuse for maintaining the status quo.
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Cornett, Janet Alexandra. "Identifying Communication Precursors to Medical Error in an In-patient Clinical Environment: A Palliative Sedation Therapy Case Study". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/23693.
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Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors.
Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis.
Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created.
Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.
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Bogutska, N. K. "Іmplementation Of The Topic "Child Abuse" At The Pediatric Education (Under The Project "Training Against Medical Error", Erasmus +)". Thesis, Сучасні підходи до вищої медичної освіти в Україні (з дистанційним під’єднанням ВМ(Ф)НЗ України за допомогою відеоконференц-зв’язку): матеріали XIV Всеукр. наук.-практ. конф. з міжнар. участю, присвяченої 60-річчю ТДМУ (Тернопіль, 18–19 трав. 2017 р.) : у 2 т. / Терноп. держ. мед. ун-т імені І. Я. Горбачевського. – Тернопіль : ТДМУ, 2017, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/13053.
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Dempsey, Jared. "Speaking up for safety : examining factors which influence nurses' motivation to mitigate patient risk by challenging colleagues in situations of potential medical error". Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=166094.
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Research suggests that individuals in the workplace might have a difficulty sharing their perceptions of risk and challenging unsafe behaviours. This thesis utilises The Theory of Planned Behaviour to examine which factors promote or hinder healthcare workers’ willingness to speak up and confront clinicians’ risky behaviours that could lead to medical error and hence endanger patient safety. The Theory of Planned Behaviour addresses issues surrounding intentions garnered from explicitly measured variables; in addition the thesis further sought to identify attitudes to speaking up using an implicit measure approach, and an approach using a computerbased, scenario-placement, reaction time methodology. Overall, the results of the thesis’s four studies suggest that nurses’ decisions to speak up are influenced by a variety of negative and positive beliefs. These beliefs include the effect speaking up has on the nurse speaking up and the patient; the support and actions of other nurses and medical personnel; and nurses feelings of confidence, knowledge and experience. Nurses also demonstrated a belief that they are more likely to speak up than their peers. Results also suggested that nurses speak up to individuals that they trust and distrust, indicating that trust and distrust are not polar opposites. The findings suggest that if speaking up is to be promoted practitioners need to address nurses’ negative beliefs—this is especially true with regard to fears about speaking up to authority figures. Nurses stated beliefs that they are more likely to speak up than their peers might be a result of presentation-bias or self-bias, if the cause is self-bias then training nurses to be more assertive and challenge risk might be made more difficult by nurses’ collective denial that they have any difficulties speaking up.
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Tafelli, Dimas Siloé. "A tutela jurisdicional da cirurgia bariátrica: uma análise sob a óticada responsabilidade civil por erro médico". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/25/25144/tde-30052017-204723/.
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O princípio da dignidade humana e da proteção à saúde são decorrentes do direito fundamental à vida. São direitos definidos como prerrogativas mínimas sem as quais o cidadão não existiria dentro do estado democrático de Direito. O pluralismo e os tempos modernos evidenciam outros problemas para a humanidade e, dentre eles, está a obesidade. Trata-se de problema que decorre de um processo histórico, expondo que a alimentação humana mudou substancialmente com a crescente urbanização, somada ao fenômeno da globalização e a disseminação da cultura de consumo, fatores que foram predominantes para o aumento exponencial desta doença. Atualmente é problema grave de saúde pública mundial, que dependendo do país e de acordo com seu desenvolvimento, pode chegar a ser causa de discriminação social, vulnerabilidade e exclusão social. Nesse aspecto, na mesma medida em que a obesidade é crescente em todo mundo, as diversas formas de sanar tal questão também são presentes. Logo, evidencia-se naturalmente constatação do crescimento das chamadas cirurgias bariátricas e, como consequência óbvia de tal aumento, a possibilidade de erros médicos em tais intervenções também é cada vez mais crescente. A medicina é atividade que pela sua própria natureza envolve riscos e lida com o bem mais essencial e fundamental. Assim, o erro médico não pode ser apenado com benevolência. Quaisquer ofensas a tais direitos são repelidas pelo Poder Judiciário que, por meio do instituto da responsabilidade civil, evidencia as premissas básicas de prudência, perícia e diligência, expondo a necessidade de atitudes regulares dos profissionais ligados à atividade médica e o bom senso na apuração de eventual ilícito, bem com condenações justas e igualitárias, pautadas na análise técnica e específica a respeito da conduta do profissional, após a observância de todos os princípios éticolegais e processuais. Assim, neste trabalho busca-se apresentar a tutela jurisdicional da cirurgia bariátrica no que diz respeito a responsabilização do médico por erro, aplicando-se a teoria da responsabilização civil e apontando-se a natureza e a ocorrência dos erros que potencializam e embasam demandas judiciais, bem como os procedimentos regulares e recomendados com o objeto de prevenir a responsabilização.The principles of human dignity and health protection are derived from the fundamental right to life. They are rights defined as the minimum prerogatives without which citizens could not exist within a democratic state. Pluralism and the modern times point to other issues for mankind, among them, obesity. This is a problem that derives from a historical process, evidenced by changes in human nutrition due to the ever-growing trend of urbanization, in addition to the phenomenon of globalization and we spread culture of consumption, which have been major factors for the exponential growth of this disease. In the present day it presents itself as a serious global public healthcare issue, and depending on which country and stage of development, may become the cause of vulnerability, social prejudice and exclusion. Meanwhile obesity has been shown to be growing worldwide, various means of addressing and solving this matter have also been made available. It may be verified a growth in the number of the so-called bariatric surgeries, and as a direct outcome, the enhanced possibility of medical failure during these procedures. The practice of medicine inherently involves risks while dealing with one´s most fundamental and essential belonging. Hence, medical failure cannot be taken lightly or benevolently. Any offenses to such rights are rebuked by the Judiciary, that bring forth the basic assumptions of prudence, skill and diligence through the institution of civil responsibility, pointing to the need for regular attitudes of medical-related professionals and proper reasoning when examining possible illicit, as well as fair and equal conviction, based on the specific technical analysis regarding the professional´s conduct, whilst observing all procedural, ethical and legal principles. Therefore, this publication intends to present the jurisdictional tutelage of bariatric surgery concerning the physicians accountability for his or her mistake by applying the theory of civil accountability, identifying the nature and occurrence of the errors that provoke or lay grounds for legal action, as well as the regular procedures advised in order to prevent accountability.
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Безруков, Л. О. y Н. К. Богуцька. "Аналіз групової взаємодії за проблемно-орієнтованого навчання в рамках тренінгу по запобіганню медичних помилок (тraining against medical error, erasmus+)". Thesis, Матеріали навчально-методичної конференції [“Актуальні питання вищої медичної та фармацевтичної освіти: досвід, проблеми, інновації та сучасні технології”], 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/13172.
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Locke, Christina. "In vivo cone photoreceptor imaging in adolescents as a measure of retinal stretch during refractive error development". The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1554723728663165.
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Öhberg, Fredrik. "Biomechanical methods and error analysis related to chronic musculoskeletal pain". Doctoral thesis, Umeå universitet, Institutionen för strålningsvetenskaper, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-18470.
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Background Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders. Methods A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations. Results Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head. Conclusion The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.
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Steyrer, Johannes, Michael Schiffinger, Huber Clemens, Andreas Valentin y Guido Strunk. "Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units". Lippincott Williams & Wilkins, 2013. http://dx.doi.org/10.1097/HMR.0b013e318272935a.
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Background: Hospitals face an increasing pressure towards efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care).
Purposes: Based on extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact.
Methodology / Approach: A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire. Linear regression was employed to identify the effects of the predictor variables on error rate, as well as interaction effects between safety tools and safety climate.
Findings: Higher workload has a detrimental effect on safety while safety climate - unlike the examined safety tools - has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant.
Practice Implications: Increased workload and capacity utilization increase the occurrence of medical error; an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies. (authors' abstract)
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Söderberg, Johan. "Sources of preanalytical error in primary health care : implications for patient safety". Doctoral thesis, Umeå universitet, Klinisk kemi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-21256.
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Background Venous blood tests constitute an important part in the diagnosis and treatment of patients. However, test results are often viewed as objective values rather than the end result of a complex process. This has clinical importance since most errors arise before the sample reaches the laboratory. Such preanalytical errors affect patient safety and are often due to human mistakes in the collection and handling of the sample. The preanalytical performance of venous blood testing in primary health care, where the majority of the patients contact with care occurs, has not previously been reported. Aims To investigate venous blood sampling practices and the prevalence of haemolysed blood samples in primary health care. Methods A questionnaire investigated the collection and handling of venous blood samples in primary health care centres in two county councils and in two hospital clinical laboratories. Haemolysis index was used to evaluate the prevalence of haemolysed blood samples sent from primary health care centres, nursing homes and a hospital emergency department. Results and discussion The results indicate that recommended preanalytical procedures were not always followed in the surveyed primary health care centres. For example, only 54% reported to always use name and Swedish identification number, and 5% to use photo-ID, the two recommended means for patient identification. Only 12% reported to always label the test tubes prior to blood collection. This increases the possibility of sample mix-up. As few as 6% reported to always allow the patient to rest at least 15 minutes before blood collection, desirable for a correct test result. Only 31% reported to have filed an incident report regarding venous blood sampling, indicating underreporting of incidents in the preanalytical phase. Major differences in the prevalence of haemolysed blood samples were found. For example, samples collected in the primary health care centre with the highest prevalence of haemolysed samples were six times (95% CI 4.0 to 9.2) more often haemolysed compared to the centre with the lowest prevalence. The significant variation in haemolysed samples is likely to reflect varying preanalytical conditions. Conclusions This thesis indicates that the preanalytical procedure in primary health care is associated with an increased risk of errors with consequences for patient safety and care. Monitoring of haemolysis index could be a valuable tool for estimating preanalytical sample quality. Further studies and interventions aimed at the preanalytical phase in primary health care are clearly needed.
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Weis, Maurine. "Improving Teamwork and Communication in the Emergency Center: A DNP Project". Mount St. Joseph University Dept. of Nursing / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1586982658645444.
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Haines, Fiona Imelda. "Error management in nursing amongst registered nurses working in a tertiary hospital in Saudi Arabia". Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80226.
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Thesis (MCurr)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Healthcare organizations have implemented numerous safety initiatives to address errors due to the impact on the patient, families, healthcare provider and the organization as highlighted in the Institute of Medicine report. However, error identification, reporting and management remain a challenge. Nurses have been identified as the healthcare provider with the greatest potential for errors. Supportive work environments are needed to provide optimal care to the nurse who makes an error; which may be minor to severe repercussions. The patient is identified as the first victim and the nurse who makes the error as the second victim. How nurse errors are reported, managed and disclosed is dependent on the response of leaders and peers which may be in a shame and blame or just culture approach. The aim of the study was to assess error management in nursing amongst registered nurses working in a tertiary hospital in Saudi Arabia. The objectives were to identify the occurrence of nursing related errors, determine the current process of reporting nursing errors, describe the management of nursing errors and explore the factors impacting on the management of nursing errors. The research methodology for this study was a descriptive, quantitative approach which is applicable when exploring the unknown. Ethical approval was obtained from the Ethics Board, University of Stellenbosch and the Institutional Review Board, King Faisal Specialist Hospital and Research Centre (General Organization) -Jeddah (KFSH&RC-J). The population was registered nurses working in KFSH&RC-J and assigned to the job descriptions of Staff Nurse 1&2, Clinical Nurse Coordinators and Assistant/Head nurses. Sample was selected using proportional allocation for nationality and simple random selection for nursing specialty; 215 RNs from these three groups. Data was collected using a questionnaire developed by the researcher and analysis completed using SPSS and regression analysis to identify factors which influences the reporting and management of errors. Data was presented in the form of frequency tables and graphs using the EXCEL program to analyze the data. The main findings of the study; there was significant difference in nurse leaders and professional nurses ability to identify nursing errors; questioning of the practice of peers, views of a non-punitive environment and the ability to differentiate between error and negligence. The nurse executive was positively associated with the average positive responses received. RNs of Middle Eastern nationality and the Adult nursing division were found to be slightly more negative in their perceptions about error reporting and management than other respondents. Improvements are needed in the processes of error reporting and management which include education; leadership development, underreporting of errors, feedback and communication, nurse manager support and disclosure of errors. Recommendations are the implementation of the Just Culture principles within the organization and leadership development to address error reporting and management. The need to develop a national database for error reporting in Saudi Arabia is recommended. Nursing errors occurred in one tertiary hospital in Saudi Arabia and an on-line system is available to report errors. However, nurses do not report errors as they fear being blamed and shamed. The process of error management within the organization has not been clearly defined.
AFRIKAANSE OPSOMMING: Gesondheidsorganisasies het talle veiligheids inisiatiewe geïmplementeer om foute aan te spreek weens die invloed wat dit het op die pasiënt, families, die gesondheidsverskaffer en die organisasie soos uitgelig in die Mediese Verslag van die Instituut. Nietemin, die identifisering van foute, verslaggewing en bestuur bly ’n uitdaging. Verpleegsters is geïdentifiseer as die gesondheidsverskaffers wat oor die grootste potensiaal beskik om foute te begaan. Ondersteunende werkomgewings word benodig om optimale sorg aan die verpleegster te verskaf wat ’n fout van ’n mindere aard tot die met ernstige gevolge begaan. Die pasiënt word geïdentifiseer as die eerste slagoffer en die verpleegster wat die fout begaan as die tweede slagoffer. Die manier hoedat verpleegfoute gerapporteer, bestuur en openbaar gemaak word, is afhanklik van die reaksies van leiers en portuurgroepe wat ’n skaamte- en blameerbenadering of “just culture”-benadering kan wees. Die doel van die studie was om die hantering van verpleegfoute tussen geregistreerde vepleegkundiges wat in n tersiêre hospital in Saudi werk te ondersoek. Die doelwitte is om die voorkoms van verpleegverwante foute te identifiseer, die huidige proses van verslaggewing van verpleegfoute te bepaal, die bestuur van verpleegfoute te beskryf en die faktore te ondersoek wat ’n impak het op die bestuur van verpleegfoute. Die navorsingsmetodologie vir hierdie studie is ’n beskrywende, kwantitatiewe benadering wat van toepassing is wanneer die onbekende ondersoek word. Etiese goedkeuring is verkry van die Etiese Raad aan die Universiteit Stellenbosch en die Institusionele Beoordelingsraad, King Faisal Specialist Hospitaal en Navorsingssentrum (Algemene Organisasie) – Jeddah (KFSH & RC-J). Die teikengroep is geregistreerde verpleegsters wat werk in KFSH & RC-J aan wie die posbeskrywing van stafverpleegster 1 & 2 toegeken is, Kliniese Verpleegkoördineerders en Assistent/Hoofverpleegsters. Die steekproef is geselekteer deur gebruik te maak van proporsionele toekenning vir nasionaliteit en ’n eenvoudige ewekansige steekproef vir verpleegspesialiteit; 215 geregistreerde verpleegsters van hierdie drie groepe. Data is gekollekteer deur gebruik te maak van ’n vraelys wat deur die navorser ontwikkel is en die analise is voltooi deur gebruik te maak van SPSS en regressie-analise om faktore te identifiseer wat verslaggewing en bestuur van foute beïnvloed. Data is aangebied in die vorm van frekwensie-tabelle en grafieke deur gebruik te maak van die EXCEL-program om die data te analiseer. Die vernaamste bevindinge van die studie is dat daar beduidende verskille tussen verpleegleiers en professionele verpleegsters se vermoë is om verpleegfoute te identifiseer; bevraagtekening van die praktyke van portuurgroepe; beskouinge van nie-strafgerigte omgewing en die vermoë om te onderskei tussen foute en nalatigheid. Die verpleegeksekuteur is positief geassosieer met die gemiddelde positiewe response wat ontvang is. Geregistreerde verpleegsters van Midde-Oostelike nasionaliteit en die Volwasse Verpleegafdeling is gevind om effens meer negatief te wees in hulle persepsies van fouteverslaggewing en bestuur, as ander respondente. Verbeterings is nodig in die prosesse van verslaggewing van foute en bestuur daarvan wat opvoeding daarvan insluit; leierskapontwikkeling, onderverslaggewing van foute, terugvoer en kommunikasie, ondersteuning van verpleegbestuur en bekendmaking van foute. Aanbevelings is die implementering van die “Just”-kultuur beginsels binne die organisasie en leierskap ontwikkeling om die verslag van foute en bestuur aan te spreek. Die behoefte om ’n nasionale databasis te ontwikkel vir die verslag van foute in Saoedi-Arabië word aanbeveel. Verpleegfoute het in een tersiêre hospitaal in Saoedi-Arabië plaasgevind en ’n aanlyn sisteem is beskikbaar gestel om foute te rapporteer. Nietemin, verpleegsters rapporteer nie foute nie, want hulle vrees om geblameer te word en beskaamd te staan. Hierdie proses van foutebestuur binne die organisasie is nog nie duidelik gedefinieer nie.
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D'Esmond, Lynn Berggren Knapp. "Distracted Practice and Patient Safety: The Healthcare Team Experience: A Dissertation". eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/41.
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Purpose: The purpose of this study was to explore the experiences of distracted practice across the healthcare team.
Definition: Distracted practice is the diversion of a portion of available cognitive resources that may be needed to effectively perform/carry out the current activity.
Background: Distracted practice is the result of individuals interacting with the healthcare team, the environment and technology in the performance of their jobs. The resultant behaviors can lead to error and affect patient safety.
Methods: A qualitative descriptive (QD) approach was used that integrated observations with semi-structured interviews. The conceptual framework was based on the distracted driving model and a completed concept analysis.
Results: There were 22 observation sessions and 32 interviews (12 RNs, 11 MDs, and 9 Pharmacists) completed between December, 2014 and July 2015. Results suggested that distracted practice is based on the main theme of cognitive resources which varies by the subthemes of individual differences; environmental disruptions; team awareness; and “rush mode”/time pressure.
Conclusions and Implications: Distracted practice is an individual human experience that occurs when there are not enough cognitive resources available to effectively complete the task at hand. In that moment an individual shifts from thinking critically, being able to complete their current task without error, to not thinking critically and working in an automatic mode. This is when errors occur. Additional research is needed to evaluate intervention strategies to reduce and prevent distracted practice.
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Chitwood, Tara Marshall. "SECOND VICTIM: SUPPORT FOR THE HEALTHCARE TEAM". Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1554820138107259.
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Alwawi, Ibrahim. "Cognitive modelling and control of human error processes in human-computer interaction with safety critical IT systems in telehealth". Thesis, Robert Gordon University, 2017. http://hdl.handle.net/10059/2680.
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The field of telehealth has developed rapidly in recent years. It provides medical support particularly to those who are living in remote areas and in emergency cases. Although developments in both technology and practice have been rapid, there are still many gaps in our knowledge with regard to the effective application of telehealth. This study investigated human colour perception in telehealth, specifically the colour red as one of the key symptoms when diagnosing different pathologies. The quality of medical images is safety critical when transmitting the symptoms of pathologies in telehealth, as distorted or degraded colours may result in errors. The study focused on the use of digital images in teleconsultation, particularly on images showing cellulitis (bacterial skin infection) and conjunctivitis (red eye) as case studies, as both of these pathologies involve the colour red in their diagnosis. The study proposed and tested the use of an image quality scale, which represented the level of image resolution; a red colour scale, which represented the intensity of redness in an image; and a confidence scale, which represented the levels of confidence that telehealth users had when judging the colour red. The research involved a series of experiments using hypothetico-deductive and formal hypothesis testing with two groups of participants, medical doctors and non-medical participants. The experiments were conducted in collaboration with the local National Health Service (NHS) Accident and Emergency (A&E) department at Aberdeen Royal Infirmary (ARI). Medical experts in ophthalmology and dermatology were also involved in selecting and verifying the relevant images. The study found that doctors and non-doctors were consistent in the majority of the experiments. The accuracy of the participants was demonstrably higher when using a colour scale with pictures, more so for the non-doctor group than the doctor group. It also found that the level of accuracy for both doctors and nondoctors was higher when using red colour scale of three divisions than when using a scale of five divisions. This result was supported by previous studies, which used telehealth for diagnosing extreme cases. The study also found that when the image quality was poor the participants had higher error rates and less consistency in their answers. The study found poor correlation between accuracy, confidence and time for both participant groups. The study found that most participants in both doctor and non-doctor groups had high confidence most of the time, whether the accuracy was high or low. It was also found that medical background or clinical experience had no effect on the accuracy level across the experiment sets. In some cases, doctors with no or little experience had higher accuracy than those with greater experience. This result may have significant implications for the feasibility of involving non-doctors in the management of telehealth systems, especially in tasks not requiring medical skills, such as colour classification. This has the potential to provide a considerable saving in resources and costs for healthcare providers. An auto-evaluation system was introduced, and proposed for further study, in order to improve the current telehealth diagnostic protocol and to avoid or prevent errors by making red colour classification more objective and accurate.
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Koehn, Amy R. "To report or not report : a qualitative study of nurses' decisions in error reporting". Thesis, Indiana University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3665927.
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This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses' decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit's expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses' experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates.
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Tomé, Patricia Rizzo. "Responsabilidade civil por erro médico". Pontifícia Universidade Católica de São Paulo, 2014. https://tede2.pucsp.br/handle/handle/6443.
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Previous issue date: 2014-04-22Conselho Nacional de Desenvolvimento Científico e Tecnológico
Our research aims to analyze the liability of the physician for injuries caused on account of errors made during his/her professional practice. These errors may result from their own acts or third parties ones, such as injuries caused by nurses working in compliance with doctors' demands. In this dissertation, the study of the contractual relationship of compromise established between doctor and patient is essential. Of special note here is the approach for full compliance of medical duties. This refers especially to the duty to provide full and clear information on an individual basis, considering each patient and his/her respective sickness. Thus, patients would be made fully aware about their particular situation and would be able to better decide whether they consent on performing surgeries or risky treatments
Nossa pesquisa tem por objetivo analisar a responsabilidade civil do médico por danos efetivamente causados em virtude de erros cometidos durante a atuação profissional. Erros estes que podem decorrer de atos próprios ou de atos de terceiros, como é o caso de danos ocasionados por enfermeiros que atuam em cumprimento de ordens médicas. Nesta dissertação, o estudo da relação contratual de meio estabelecida entre o médico e o paciente é fundamental. Destaca-se, sobretudo, o enfoque do cumprimento integral dos deveres médicos, em especial, o dever de prestar a informação completa e transparente de maneira individualizada, considerando cada paciente em relação a sua doença, para que as pessoas possam daí sim, amplamente esclarecidas, consentirem sobre a realização de cirurgias ou tratamentos de risco
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Garwood-Gowers, Penelope. "A comparison between a doctor-pharmacist collaborative model and the usual medical model for perioperative prescribing of medications in an anaesthetic-led pre-admission clinic". Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/206990/1/Penelope_Garwood-Gowers_Thesis.pdf.
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Pharmacist prescribing in an anaesthetic-led pre-admission clinic.
This thesis investigates if a doctor-pharmacist collaborative prescribing model provides better care than the usual (medical) prescribing model in a medium sized hospital, anaesthetic-led pre-admission clinic setting. The doctor-pharmacist collaborative prescribing model was found to improve safety and quality of prescribing patients’ usual home medications, and provided better compliance for appropriate surgical antibiotic prophylaxis prescribing versus the usual prescribing model of care. Other benefits are saved doctor time and high patient satisfaction.
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Сай, Л. М. "Деякі аспекти тлумачення поняття лікарської помилки". Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/34119.
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Охорона здоров'я є однією з найважливіших галузей соціальної сфери України, що нараховує тисячі медичних установ. Праця медичних працівників безпосередньо пов'язана з реалізацією конституційного права людини і громадянина на охорону здоров'я, медичну допомогу і медичне страхування. Ефективна організація праці медичних працівників є одним з основних факторів, що забезпечують суспільне та особисте здоров'я і, як наслідок, обумовлює соціальну стабільність у суспільстві.
При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/34119
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Graziano, Analucia. "Responsabilidade civil médica por erro de diagnóstico: critérios para a identificação do erro de diagnóstico e o resultado falso-positivo e falso-negativo". Pontifícia Universidade Católica de São Paulo, 2010. https://tede2.pucsp.br/handle/handle/8924.
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Previous issue date: 2010-05-27In line with the idea of rule of law and consequent incompatibility with the irresponsibility of its members, the vast expansion of the area of liability is accompanied by the growing interest of society to find solutions that make effective compensation for damage. It forms new doctrine, concerned with protecting the citizens most vulnerable and helpless. It turns out that the increasing number of complaints begins to disrupt society in general, to increase the financial cost for the professional and the patient because of the increase especially in the application of more sophisticated laboratory tests and refusal to higher-risk procedures, contributing to a consolidation of defensive medicine. The aim of this paper is to provide measures to prevent the questioning of the patient-consumer for the health services used by it. Are brought to bear upon some criteria such as time, sensitivity and specificity of diagnostic method for identification of medical errors. The consent form is also shown as a measure capable of preventing the questions, eliminating or reducing some complications related to relationship conflict or miscommunication between doctor and patient. In the context of public institutions to private, is necessary a detailed analysis of the legal systems adopted. So rich, the issue is not limited to the material aspect, so deals some specific procedural rules, which directly influence the demand indemnification, as the burden of proof. Case law and doctrine and comparative national basis and reap the practical utility of each issue discussed
Em consonância com a idéia de Estado de direito e consequente incompatibilidade com a irresponsabilidade dos seus membros, a grande expansão da área da responsabilidade civil é acompanhada do crescente interesse da sociedade em buscar soluções que tornam efetiva a reparação do dano. Forma-se nova doutrina, preocupada com a proteção aos cidadãos mais frágeis e desamparados. Ocorre que o crescente número de queixas começa perturbar a sociedade em geral, por aumentar o custo financeiro para o profissional e para o paciente em razão especialmente do aumento no pedido de exames complementares mais sofisticados e recusa em procedimentos de maior risco, contribuindo para uma consolidação de uma medicina defensiva. O objetivo do presente trabalho é fornecer medidas capazes de prevenir os questionamentos do paciente-consumidor, relativos aos serviços de saúde utilizados por ele. São trazidos à baila alguns critérios como tempo, sensibilidade e especificidade do método de diagnóstico para a identificação do erro médico. O termo de consentimento esclarecido é também apontado como medida capaz de prevenir os questionamentos, eliminando ou reduzindo algumas causas ligadas a conflitos de relacionamento ou de falha de comunicação entre médico e paciente. No âmbito das instituições públicas a privadas, se faz necessária uma minuciosa análise sobre os regimes jurídicos adotados. De tão rico, o tema não se esgota no aspecto material, por isso pincela algumas particularidades processuais, que diretamente influenciam as demandas indenizatórias, tal como o ônus da prova. O estudo de mecanismos alternativos de recomposição dos acidentes médicos ajuda, também, a compreender melhor que a simples decisão de criar novas hipóteses de responsabilidade objetiva ou adotar um sistema alternativo de solidariedade nacional deve levar em conta a sua viabilidade em termos práticos, e não apenas teórico. Da jurisprudência e doutrina nacional comparada colhe-se o fundamento e a utilidade prática de cada questão discutida
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Поворознюк, Анатолій Іванович y Ганна Євгенівна Філатова. "Формалізація етапів діагностично-лікувальних заходів при проектуванні систем підтримки прийняття рішень в медицині". Thesis, Прикарпатський національний університет ім. Василя Стефаника, 2017. http://repository.kpi.kharkov.ua/handle/KhPI-Press/46344.
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Формалізовано етапи діагностичнолікувального процесу при проектуванні комп'ютерних систем підтримки прийняття рішень в медицині. Розроблено математичну модель процесу діагностики та лікарських дій з метою підвищення ефективності надання медичних послуг та мінімізації ризиків лікарських помилок.The stages of the diagnostic and therapeutic process in the design of computer decision support systems in medicine are formalized. The mathematical model of the process of diagnostics and medical actions for the purpose of increasing the efficiency of providing medical services and minimizing the risks of medical errors is developed.
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Grodrian, Stanley Wayne. "High Reliability at a U.S. Air Force Outpatient Clinic: Have We Improved and are We Ready for the Future". Franklin University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=frank1628018844639682.
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Van, der Westhuizen Gareth. "Design, implementation & analysis of a low-cost, portable, medical measurement system through computer vision". Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6764.
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Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2011.ENGLISH ABSTRACT: The In the Physiotherapy Division of the Faculty of Health Sciences on the Tygerberg Hospital Campus of the University of Stellenbosch, the challenge arose to develop a portable, affordable and yet accurate 3D measurement machine for the assessment of posture in school children in their classroom environment. Currently Division already uses a state-of-the-art VICON commercial medical measuring machine to measure human posture in 3D in their physiotherapy clinic, but the system is not portable and is too expensive to cart around to different places for testing. To respond to this challenge, this Master’s thesis designed and analyzed a machine and its supporting system through both research on stereo-vision methodologies and empirical appraisal in the field. In the development process, the research was required to overcome the limitations posed by small image resolutions and lens distortions that are typical of cheap cameras. The academic challenge lay in the development of an error prediction model through Jacobian derivation and Error Propagation Law, to predict uncertainties of angular measurement calculated by the system. The research culminated in a system that is comparable in accuracy to the VICON within 3mm, and that has 1.5mm absolute accuracy within its own system for a measurement volume radius of 2.5 m. As such, the developed error model is an exact predictor of the angular error to within 0.02° of arc. These results, for both system accuracy and the error model, exceed the expectations on the basis of the initial challenge of the system. The development of the machine was successful in providing a prototype tool that is suitable for commercial development for use by physiotherapists in human posture measurement and assessment. In its current incarnation, the machine will also serve the Engineering Faculty as the most fundamental form of a three-dimensional measuring apparatus using only basic theories and algorithms of stereo-vision, thereby providing a basic experimental platform from which further scientific research on the theory and application of computer vision can be conducted.
AFRIKAANSE OPSOMMING: Die Fisioterapie Afdeling van die Fakulteit Gesondheidswetenskappe op die Tygerberg kampus van die Universiteit van Stellenbosch gebruik ’n allernuutste VICON kommersiële mediese meettoestel om menslike postuur in drie dimensies te meet. Vanuit hierdie Afdeling het die uitdaging ontstaan om ’n draagbare, bekostigbare, maar tog akkurate, drie-dimensionele meetapparaat geskik vir die meet van die postuur van skoolkinders in die klaskamer te ontwikkel. In aanvaarding van hierdie uitdaging, het hierdie Magistertesis ’n toestel en ondersteuningstels ontwerp en ontleed deur beide navorsing in stereo-visie metodiek en terplaatse beoordeling. In die ontwikkelingsproses moes die navorsing die beperkings wat deur klein-beeld resolusie en lens-distorsie (tipies van goedkoop kameras) meegebring word, oorkom. Die akademiese uitdaging lê in die ontwikkeling van ’n voorspellende foutmodel deur van die Jacobianse-afleiding en die Fout Propageringswet gebruik te maak om onsekerheid van hoeksberekening deur die stelsel te voorspel. Die navorsing het gelei tot ’n stelsel wat binne 3mm vergelykbaar is in akkuraatheid met dié van die VICON en ook 1.5mm absolute interne akkuraatheid het in ’n meet-volume radius van 2.5m radius. Die ontwikkelde foutmodel is dus ’n presiese voorspeller van hoekfout tot binne 0.02° van boog. Die resultate met betrekking tot beide die akkuraatheid en die foutmodel het die oorspronklike verwagtinge van die uitdaging oortref. Die ontwikkeling was suksesvol in die skep van ’n prototipe-toestel geskik vir kommersiële ontwikkeling, vir gebruik deur fisioterapeute in die meting en evaluering van menslike postuur. Die stelsel is in sy fundamentele vorm, deur die gebruik van slegs basiese teorieë en algoritmes van stereo-visie, funksioneer as ’n drie-dimensionele meetapparaat. In die fundamentele vorm sal die stelsel die Ingenieursfakulteit dien as ’n basiese eksperimentele platform waarop verdere wetenskaplike navorsing in die teorie en toepassing van rekenaar-visie gedoen kan word.
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Bisetto, Lucia Helena Linheira. "Evento adverso pós-vacinação e erro de imunização: da perspectiva epidemiológica à percepção dos profissionais da saúde". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-25102017-164703/.
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Introdução: o aumento da cobertura vacinal reduziu a incidência das doenças imunopreveníveis, elevando os casos de Evento Adverso Pós-Vacinação e Erro de imunização. Objetivo: analisar os erros de imunização e a percepção de vacinadores sobre os fatores que contribuem para a sua ocorrência. Método: abordagem mista, desenvolvida em duas fases: primeira, quantitativa, descritiva, documental, retrospectiva, no período de 2003 a 2013. Utilizados dados secundários do Brasil e primários e secundários do Paraná Sistema de Informação de Eventos Adversos Pós-Vacinação e relatório de erros de imunização do Programa de Imunização. A segunda, qualitativa, exploratória, prospectiva, tendo como referencial a Teoria do Erro Humano, realizada com vacinadores da Região Metropolitana de Curitiba que notificaram erro de imunização em 2013. Classificação do erro de imunização: com evento adverso e sem evento adverso. Para o cálculo das taxas de incidência de erro e diagrama de dispersão, foi utilizado o software SPSS versão 23.0 ajustados pelo Modelo de Regressão Linear Simples. Na fase II, os dados foram coletados por meio de entrevistas e observação não participante, analisados segundo Bardin, utilizando o Web Qualitative Data Analysis WebQDA. Resultados: de 2003 a 2013, no Brasil e no Paraná, o abscesso subcutâneo quente foi o erro de imunização com evento adverso mais frequente. Os menores de um ano foram os mais atingidos pelos erros e a BCG teve taxa de incidência mais elevada. A incidência do erro de imunização com evento adverso aumentou ao longo do período, enquanto o sem evento adverso, elevou-se expressivamente em 2012. A análise da tendência no Paraná de 2003 a 2018, revelou crescimento anual, com elevação contínua da incidência, para ambos, mostrando ainda que a elevação dos percentuais e taxas ocorreu nas campanhas de vacinação, introdução de novas vacinas e mudanças no Calendário Nacional de Vacinação. Nas observações das 26 salas de vacinação, identificou-se: refrigerador não exclusivo, falhas na higienização das mãos (78%), não abordagem sobre possíveis contraindicações ou adiamento da vacinação. Foram entrevistados 115 vacinadores, 96% mulheres, 42% entre 30 a 39 anos, 54% com nível médio de escolaridade e 53% formados há cinco anos ou mais. Atuavam na sala de vacinação entre 3 a 11 anos, 71% realizavam atividades concomitantes em outros setores e 76% não tinham outro emprego. A entrevista revelou que 47% dos vacinadores tinham conhecimento de erro de imunização no seu trabalho, 8,7% estiveram envolvidos em erros e 1,7% referiram haver subnotificação. Dos discursos dos vacinadores emergiram três categorias analíticas: fatores humanos (57,3%), institucionais/organizacionais (34%) e ambientais (8,7%). Das categorias empíricas, destacou-se fatores psicológicos (43,2%) e das subcategorias: distração (21,4%) e estresse (20,9%). Conclusões: o erro de imunização é causado pela interação de múltiplos fatores. Mantendo-se os cenários, as incidências de erro de imunização, com ou sem evento adverso, tendem a continuar ascendentes até 2018. Campanhas, novas vacinas e mudanças no calendário de vacinação aumentam o risco de erro de imunização. Na visão dos vacinadores, a ocorrência de erro de imunização está relacionada, principalmente, a fatores psicológicos e gestão de pessoas. A maioria dos erros de imunização é potencialmente prevenível, desde que a sua ocorrência e causas sejam identificadas.Introduction: the increase in vaccination coverage reduced the incidence of vaccine-preventable diseases, increasing the number of cases of Adverse Events Following Vaccination and Immunization Error. Objective: to analyze the immunization errors and the perception of vaccinators on the factors that contribute to their occurrence. Method: mixed approach, developed in two phases: the first being quantitative, descriptive, documentary, retrospective, in the period from 2003 to 2013. Secondary data from Brazil and primary data from Paraná were used Surveillance System of Adverse Events Following Vaccination and immunization error reports of the Immunization Program. The second, qualitative, exploratory, prospective phase had as reference the Theory of Human Error, performed with vaccinators of the Metropolitan Region of Curitiba who reported immunization errors in 2013. Classification of immunization error: with and without adverse event. For the calculation of the incidence rates of error and dispersion diagram, the SPSS software version 23.0 was used, adjusted through the Simple Linear Regression Model. In phase II, the data were collected through interviews and non-participant observation, analyzed according to Bardin, using the Web Qualitative Data Analysis WebQDA software. Results: from 2003 to 2013, in Brazil and Paraná, warm subcutaneous abscess was the most frequent immunization error with adverse event. Children under one year old were the most affected by the errors and BCG had higher incidence rate. The incidence of immunization error with adverse event increased over the period, while its incidence without adverse event increased significantly in 2012. The analysis of the trend in Paraná from 2003 to 2018 showed annual growth, with continuous increase in incidence, for both, also showing that the increase of the percentages and rates occurred during the vaccination campaigns, introduction of new vaccines and changes in the National Vaccination Calendar. During the observation of the 26 vaccination rooms, the following were identified: non-exclusive cooler, failures in the sanitation of hands (78%), no addressing of the possible contraindications or postponement of vaccination. 115 vaccinators were interviewed, 96% women, 42% between 30 and 39 years of age, 54% with average level of education and 53% graduated for five years or more. They had been working in the vaccination room for 3 to 11 years, 71% performed concomitant activities in other sectors and 76% did not have another job. The interview revealed that 47% of vaccinators were aware of immunization errors in their work, 8.7% were involved in errors and 1.7% declared there being underreporting. The speeches of the vaccinators resulted in three analytical categories: human (57.3%), institutional/organizational (34%) and environmental (8.7%) factors. Those which stood out, of the empirical categories, were the psychological factors (43.2%), and of the subcategories, distraction (21.4%) and stress (20.9%). Immunization error is caused by the interaction between multiple factors. Conclusions: if kept constant, the scenarios and incidence of immunization errors, with or without adverse event, tend to continue increasing up to 2018. Campaigns, new vaccines and changes in the vaccination calendar increase the risk of immunization error. For the vaccinators, the occurrence of immunization error is related mainly to psychological factors and people management. Most immunization errors are potentially preventable, provided their occurrence and causes are identified.
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Khoury, Gregory Robert. "A strategic, system-based knowledge management approach to dealing with high error rates in the deployment of point-of-care devices". Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/96206.
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Thesis (MBA)--Stellenbosch University, 2014.There is a growing trend towards the use of point of care testing in resource poor settings, in particular in the diagnosis and treatment of infectious diseases such as Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria. The Alere PIMA CD4 counter is widely used as a point of care device in the staging and management of HIV. While the instrument has been extensively validated and shown to be comparable to central laboratory testing, little is known about the error rates of these devices, as well as the factors that contribute to error rates. This research was a retrospective analysis of error rates from 61 PIMA point of care devices deployed in nine African countries belonging to Medisciens Sans Frontiers. The data was collected between January 2011 and June 2013. The objectives of the study were to determine the overall error rate and, where possible, determine the root cause. Thereafter the study aimed to determine the variables that contribute to the root causes and make recommendations to reduce the error rate. The overall error was determined to be 13.2 percent. The errors were further divided into four root causes and error rates assigned to each root cause based on the error codes generated by the instrument. These error rates were found to be operator error (48.4%), instrument error (2.0%), reagent/cartridge error (1%) and sample error (4.3%). It was found that a high percentage of the errors were ambiguous (44.3%), meaning that they had more than one possible root cause. A systems-based knowledge management approach was used to create a qualitative politicised influence diagram, which described the variables that affect each of the root causes. The influence diagram was subjected to loop analysis where individual loops were described in terms of the knowledge type (tacit or explicit), the knowing type (know-how, know-who, know-what and know-why), and the actors involved with each variable. Where possible, the variable was described as contributing to pre-analytical, analytical or post-analytical error. Recommendations to reduce the error rates for each of the variables were then made based on the findings.
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Debesai, Yohannes. "Strategies Healthcare Managers Use to Reduce Hospital-Acquired Infections". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6414.
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Every year, 2 million patients in the United States suffer with at least 1 hospital-acquired infection resulting in an estimated 99,000 deaths annually. The purpose of this exploratory single case study was to explore strategies healthcare managers in U.S. hospitals used to reduce hospital-acquired infections. The study included face-to-face, semistructured interviews with 5 healthcare managers from a hospital in Maryland who were successful in reducing these infections. The conceptual framework was human capital theory. Field notes, hospital documents, and transcribed interviews were analyzed to identify themes regarding strategies used by healthcare managers. The data analysis and coding process resulted in 5 major themes: use of HAI-related data; implementation of detailed cleaning method; implementation of define, measure, analyze, implement, and control; education and training of staff; and implementation of the Antimicrobial Stewardship Program. The findings from this study might benefit healthcare managers in implementing and sustaining successful strategies to reduce hospital-acquired infections. The implications for positive social change included reducing hospital-acquired infections, thereby leading to fewer hospitalization days for patients and a faster recovery time to return to normal life. Reducing hospital acquired infections might reduce patient deaths related to the infections.
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Alvarez, George Francisco Centre of Health Informatics UNSW. "Interruptive communication patterns in the intensive care unit ward round". Awarded by:University of New South Wales. Centre of Health Informatics, 2006. http://handle.unsw.edu.au/1959.4/23430.
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Medical error and patient safety have become important issues. It is clear that medical error is more influenced by systemic factors rather than human characteristics. Communication patterns, in particular interruptive communication, maybe one of the systemic factors that contribute to the burden of medical error. Objective: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit during ward rounds. Methods: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 hours, using the Communication Observation Method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. Results: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95%CI 33.9-40.1] of total communication event time (5hr: 53min). T.T.I. accounted for 5.3% of total communication event time (56min). Conclusion: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.
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Gustavsson, Susanne. "Från avvikelse till förbättring : innehåll i registrerade patientavvikelser". Thesis, University of Skövde, School of Life Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-2595.
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I den svenska vården drabbas uppskattningsvis var tionde patient av en vårdskada, det vill säga en undvikbar skada direkt orsakad av vården (Socialstyrelsen, 2008; Ödegård, 2007). Vårdskador ska registreras som avvikelser som sedan ska analyseras för att finna orsak och ligga till grund för förbättringsarbete (Socialstyrelsen, 2008). Syftet med studien är att beskriva innehållet i de patientavvikelser som registrerats av personal på sjukhus. Innehållet beskrivs avseende vilka händelser som registrerats och vårdpersonalens beskrivningar av händelseförloppet. Studien innehåller både kvalitativa och kvantitativa delar. Den kvalitativa delen genomfördes med innehållsanalys enligt Graneheim och Lundman (2004). Den kvantitativa delen redovisas med hjälp av deskriptiv statistik. Resultatet av studien visar att de flesta avvikelser berör Organisation/regler/resurser, Vård och behandling samt Halk/fall. Patienter i åldern 70-90 år drabbas i störst utsträckning. Händelseförloppet är ofta detaljerat beskrivet. Personal är däremot mindre benägen att skriva vad de anser vara orsak till det inträffade, samt bidra med förbättringsförslag. Teman som kom ur den kvalitativa analysen var: ”Det blir arbetsamt när andra gör fel”, ”Att vara nära men inte inpå” och ”Att lindra lidande”.