Biography:

Puteri Nemie Jahn Kassim is a Professor in the Civil Law Department, Ahmad Ibrahim Kulliyyah of Laws at International Islamic University, Malaysia. She has completed her LLB (with Honours) degree at the University of Southampton, England and Postgraduate studies (Masters of Comparative Laws and Doctor of Philosophy in Law) at the International Islamic University Malaysia. She is currently teaching Law of Torts and Medical Law at undergraduate level and Medical Negligence Law at the postgraduate level. Her books entitled “Nursing Law and Ethics”, “Medical Negligence Law in Malaysia” and “Law and Ethics relating to the Medical Profession are published by the International Law Book Services. She has also edited a book entitled “Issues in Medical Law and Ethics”. Other publications include articles in reputable local and international journals. She is also active in presenting papers at both the national and international arena.

Abstract:

The changing legal landscapes in judicial approaches in preferring patient-centered approaches as the benchmark for good medical practices has subsequently increase the medical profession’s legal obligations towards their patients. The medical profession is constantly expected to adhere to the demands of patient autonomy and rights of self-determination in various aspects of medical care. Thus, in achieving patient safety goals which emphasizes on safe medical practices as well as minimizing risks of harm to patients, the medical profession should always keep abreast with the legal developments that are affecting their practice. Knowledge of these legal developments will eventually prepare them to handle medico-legal issues and eventually, reduce the likelihood of court litigation. Further, lawsuits can also be alleviated through effective communication which is also amongst the main goals of patient safety. The promotion of open-disclosure’ policies and honest communication will encourage reconciliation, strengthen doctor-patient relationship and ultimately, safeguard public trust in the medical profession. Nevertheless, open-disclosure policies which one of the key ingredients includes making apologies or expressions of regret must be developed in tandem with a comprehensive legal framework that shields those making apologies from legal liability. Thus, the enhancement of legal knowledge coupled with effective disclosure policies are crucial in overcoming the impending barriers towards the achievement of patient safety goals in the modern healthcare setting.

Biography:

Working as a Lecturer at Sultan Qaboos University (SQU), College of Nursing from 2015 to date. Currently working on a project titled Family caregiver burden of patient's with Traumatic Brain Injury", funded by SQU. Currently teaching Adult Health Nursing & Critical Care Nursing for the Bachelor's Program in nursing at SQU.Worked at various Hospitals and College of Nursing in India and Oman- from1999.Staff nurse in the medical, surgical wards and ICU at Manipal & Bangalore Baptist Hospital India. Continuing Nursing Education Coordinator - Manipal Hospital India.Junior Lecturer - St.John's College of Nursing. India.Program Coordinator of a WHO funded project -Global Fund to fight against AIDS TUBERCULOSIS AND MALARIA (GFATM) at St. John's National Academy of Health Sciences, St.John's College of Nursing, India. Technical Officer for Maternal Health Task Force, Lotus Research Institute, St.John's National Academy of Health Sciences, India, training doctors and nurses to reduce the Infant & Maternal Mortality Rate of selected regions in Karnataka - India. Civilian Officer at the Armed Forces Hospital - Muscat.

Abstract:

Background: Nurse educators plays a major role in ensuring student nurses to develop the knowledge, competency, skill and judgement related to safe medications administration. In recent years, the use of high fidelity simulation in educating student nurses enables the practice of necessary skills in an environment that allows for errors and professional growth without risking patient safety.

Objective: This study aimed to explore the effect of simulation based learning on student nurses knowledge and competency related to managing critically ill patients.

Methods: This non-experimental quantitative survey was conducted between August 2015 to May 2017, among fourth year nursing students at Nursing Education and Clinical Simulation Unit (NECSU) of the College Of Nursing, Sultan Qaboos University, Muscat. The students were exposed to faculty guided simulation program which included pre-learning skill stations, standardized simulation scenarios, standardized patients and high fidelity manikins and pre-learning checklists. Participants answered a pre-test questionnaire prior to simulation sessions on patient identification, focused assessment, effective communication skills using SBAR, critical thinking for clinical judgement and safe administration of medication in managing Acute myocardial infarction, hypovolemic shock and life threatening complications. The questionnaire was administered as a post-test. Items were classified into subcategories such as knowledge, skill, medication safety and critical thinking.

Results: Of the 80 participants majority of the students (78.81%) had improved levels of medication safety practices when compared with the pretest score (46.22%). There was also a significant increase in knowledge scores from 56.08% to 76.43%. Skill competencies were augmented by 65.1%. Apparently there was a significant increase (71.72%) in critical thinking and clinical judgement in comparison with pre-test scores of (60.26%).

Conclusion: Thus the results reflect that simulation revamps their knowledge, skill, medication safety and critical thinking levels in identifying and managing critically ill patients. These findings strongly reinforce the use of simulation as a strategy to train students in providing safe care to patients.

Biography:

I have MPH with Public Health background with 13 years of experience on Maternal, child and neonatal health service. Currently I am working with IntraHealth International on USAID funded project as Quality assurance and Improvement Advisor. Mr Aklilu is in process for publishing four QI interventions and one operational research. I have serving as national quality steering committee for reviewing strategy, intervention package and design innovative approach for quality improvement. In addition, I am member of Quality Equity and Dignity Network of WHO and at international conference I had presented project implementation experience on death reduction intervention through quality improvement.

Abstract:

Background: Developing regions of Ethiopia (Afar, Benishangul-Gumuz, Gambella and Somali) have the country’s worst maternal health including family planning outcome. USAID-supported Transform: Health in Developing Regions (T-HDR) project, led by AMREF with sub partner of IntraHealth, is working with the Federal Ministry of Health to drive large-scale improvements in MNCH/FP clinical performance including access, utilization and quality of care.

Methods: A descriptive cross-sectional survey was employed from September- October 2018 using three data collection methods: 1) medical record review, 2) interviews with health workers and mothers, 3) observations through semi-structured questionnaires. Using simple random sampling, 580 medical records were reviewed to determine provision of care and use of national recommended standards.

Results: Only 37% of HCs are practicing BEmONC signals in four regions and 48% of HCs used partographs routinely. Routine infection prevention measures are practiced in 86% of facilities: 74% HCs, 98% hospitals. 48% of HCs lacked continuous water supply and 67% of HCs lacked access to electricity (including generators). Only 6% of HCs apply quality improvement processes, 17% of hospitals have functional quality improvement teams. Providers lack sufficient knowledge of postpartum hemorrhage, eclampsia management, and treatment of newborn sepsis, despite reporting they had this knowledge.

Conclusion & Recommendations: Regional health bureaus and hospitals need supportive supervision and catchment-based mentorship to improve knowledge and skills of providers and application of national protocols for service quality. Multi-stakeholder collaboration and commitment among bureaus and other government sectors is required for allocation of needed resources.

Biography:

Abstract:

Optimizing Strength & Resilience is an organizational intervention designed to promote an integrated approach to physical and psychological health through the application of biomedicine, cognitive science and behavioral theory in an acute NHS Trust. The intervention was aimed at NHS staff members in recognition of the high levels of work-related stress which impacts upon staff wellbeing and patient safety, building on the recent calls from the General Medical Council (GMC) and Royal College of Nursing (RCN) to address stress and promote strength and resilience training. The programme sought to address three main challenges: 1. the relationship between NHS staff wellbeing and how this translates into high quality, safe care for patients. 2. Physical and psychological health problems in NHS staff; 3. The challenge of strengthening a compassionate organisational healthcare culture.  Employing a strengths-based, reflective practice framework, the programme was delivered through multi-media communication platforms and work streams including workshops, committee work, lectures, change champions and the development of strategy linked to policy. During the programme 161 staff attended workshops. Pre- and post-workshop measures showed a significant increase in: wellbeing, knowledge of stress, confidence managing stress and feelings of resilience.  Results also showed a significant reduction in psychological distress and mental health stigma.  Overall, the programme was well-received and led to increased knowledge, improvements in wellbeing, promotion of positive health behaviours and a reduction in mental health stigma. The project team is currently promoting and delivering the programme to NHS staff members in the South West London region.

Biography:

Abstract:

Background: Incident-reporting systems (IRSs) help improve both the safety and quality of healthcare delivery system by obtaining information about incidents affecting patient safety which can be converted into individual and organizational learning and improvement opportunities. This study aims to evaluate the effectiveness of IRS in incident reporting at JHAH since the implementation of Datix.

Methods: This is a prospective, qualitative and quantitative study. Datix and SAP reports are used to evaluate incident reporting before and after implementing the software. Qualitative methods using a questionnaire that was developed to assess the attitude of JHAH’s staff towards reporting incidents in general and the use of Datix.

Results: Incident reporting has increased significantly in 2017 and 2018 by 84% and 92% respectively using Datix compared with the previously implemented software. JHAH has 3812 active employees with nearly 60% of them using Datix. The study received 377 survey responses. Mixed attitudes were held about the workplace safety culture and the value of the system.

Conclusion: The system implementation was successful. Problems identified that may affect reporting include more increased awareness regarding the importance of incident reporting and more training on Datix.

Biography:

Pooraj Rumon is a Registered Nurse and has been working as Assistant Nurse Manager at Cleveland Clinic Abu Dhabi since November 2014 in the Heart and Vascular Institute, Acute care and Telemetry. Pooraj has recently completed a Master Degree is Health Service Management and also has a Master Degree in Nursing awardeMassey University of New Zealand. He also holds a Green Belt certification awarded few months ago. On 25th of October 2017, Pooraj received a DAISY award nominee andwas awarded a pin at Cleveland Clinic Abu Dhabi. Currently, Pooraj is working on a fall prevention project Pooraj Rumon lives in Abu Dhabi, the capital of the    United Arab Emirates.

Abstract:

Background: Influenza and Pneumococcal diseases are major causes of morbidity and Mortality across the globe. Standing orders are great way to increase the compliance rates  and reduce missed opportunities. The purpose of this study is to assess barriers to Influenza and pneumococcal vaccination assessment and administration in the inpatient settings.

Methodology: For the purpose of data collection, a questionnaire was developed. The survey consisted of eleven questions which were obtained from previous studies, following a literature review and took 5-8 minutes of caregiver’s time to complete. The survey was Conducted in 5 acute care units at Cleveland Clinic Abu Dhabi during the first week of March 2017. An information sheet along with the survey was emailed to the Assistant Nurse Managers of the ACUs to help with data collection. Completing and returning the survey was implied as consent to take part in the survey. Participation was voluntary and Participants were not required to provide any demographic details, making the survey Anonymous. Data analysis was completed with Microsoft Excel 2013.

Results: 123 questionnaires (response rate of 58%) were collected for data analysis; Findings from this study reveal that physician’s preference does not prevent the Administration of these vaccines. More than 50% of caregivers agree that Day of Discharge is the appropriate time for vaccinations and almost 50% believed more training is required with the assessment and administration of vaccines. 75% believed that SOP will be an Effective way of ensuring eligible patients is vaccinated.

Conclusions: The results of the survey suggest the need for more staff education on Immunization assessment and administration and also the development of a SOP to achieve a higher compliance rates. Future research is needed at the hospital to assess the barriers to Influenza and pneumococcal vaccination assessment and administration in the acute settings.

Biography:

Stacey Stone and Prabhu S Parimi has passion in value-based health care delivery model. In contrast to numerous clinical providers with variable expertise providing care for newborn infants, both physicians are of the firm belief that if a highly specialized expert care team is assembled around a clinical condition/procedure, it will create value to all the stakeholders and improve clinical outcomes. The submitted work is of many initiatives these authors have undertaken to provide high value to patients in the neonatal ICU. Together, they have formed a High Value Care Team in the Maternal Fetal and Neonatal Institute at Johns Hopkins All Children’s 

Abstract:

Statement of the Problem: Advanced Practice Providers (APP's) and bedside RN’s dual role to place peripherally inserted central catheters (PICC) while maintaining their regular patient assignment may delay insertion, compliance to maintenance, and timely discontinuation of PICC. This may contribute to prolonged umbilical venous catheter (UVC) dwell time, higher stage IV infiltrates and CLABSI. Inefficiencies such as the preceding hampers care teams. We hypothesized that deploying a skilled and dedicated core team (NVA-HVC) coupled with engagement of organizational leaders creates value. The purpose of this study is to evaluate the impact of a structured NVA-HVC team on process measures, clinical outcomes and escalation to surgical intervention. Methodology & Theoretical Orientation: NVA-HVC team composed of a physician champion, two dedicated expert RN’s, QI staff and CNO was created. Process, outcomes and balanced measures were established apriori. Adherence to established processes and Stage 3-4 PIV infiltrates and CLABSI were the primary outcome measures. Findings: Among 523 newborn infants enrolled prospectively, PICC was successfully inserted in 92.8% of patients during a single session (< 3 attempts). Mean time to insert PICC was 1 day and discontinued at an enteral feed volume of 107 ml/kg/d; all but few data points fell between the upper and lower control limits. There was a significant reduction in Stage 3-4 PIV infiltrates and CLABSI (p<.01) compared to pre-NVA HVC epoch. In only 7.2% of patients care was escalated to have PICC or broviac placed by IR/surgical staff. Conclusion & Significance: Employing a High Value Care team strategy surrounding PICC insertion can be a powerful means to reduce process variation, minimize use of less skilled staff, create value and improve outcomes.

Biography:

Linh Nguyen is a Clinical Associate Professor in the Department of Anesthesiology and Perioperative Care at the University of Texas, MD Anderson Cancer Center. She teaches residents and student nurse anesthetists, and has a strong interest in improving patient safety.

Abstract:

Statement of the Problem: With enhanced recovery after surgery programs, acetaminophen is increasingly used in multimodal, opioid- sparing analgesia. At our institution, some surgeons order oral acetaminophen to be given in the holding area prior to surgery. There is no communication from the surgeon to the anesthesia team regarding these orders. From the responses of a survey administered to anesthesia providers, the preoperative nurses have identified a patient safety issue. The survey found that the anesthesia team is often unaware that the patient received the oral acetaminophen preoperatively. This raises the concern of a medication error, as the patient may inadvertenly be given a second dose of acetaminophen intravenously in the operating room.

Methodology & Theoretical Orientation: To reduce the likelihood of medication overdosing, we implemented a change in the electronic health record (EHR). A pop up warning alerts the anesthesia provider that the patient already received a dose of acetaminophen. Its effectiveness in preventing double dosing errors requires that the anesthetist administering the medication enters it first into the HER prior to physically giving it to the patient.

Findings: Medication errors have been identified as the most common type of error affecting the safety of patients and the most common single preventable cause of adverse events. Moreover, acetaminophen overdose has been a significant patient safety issue in the United States and is among the leading causes of drug toxicity, surpassing liver failure from hepatitis. There are 38,000 hospitalizations and over 50,000 emergency center visits annually related to acetaminophen overdose. Factors related to the individual and system contributes to medication errors. The anesthesia practice is different from the setting in other parts of the hospital. The anaesthesia provider is typically the only practitioner involved in the entire process, prescribing, formulating, dispensing and administering the medication, thus removing the protection of double checks that exist in other hospital areas.

Conclusion & Significance: Medication errors occur with a reported frequency of 1 in 133 anesthetics. Multiple efforts to reduce errors include bar code scanning, color coded labels and prefilled syringes. The acetaminophen pop up is an additional aid in the armamentarium, and may be used with other medications to alert the anesthetist where the risk of overdosing is deemed high.

Biography:

Sato Yukiko has completed her PhD at Tohoku University, Graduate School of Education. She is a Professor in the School of Nursing at Yamagata University.

Abstract:

Purpose: It is difficult for children with psychosomatic and neurotic disorders to provide an accurate response when faced with questions by a friend regarding the physical symptoms of the disorder and during consultation with a therapist. In such situations, it is necessary to implement social skills training (SST). The purpose of this study was to extract the elements of SST necessary to help children with psychosomatic and neurotic disorders cope with difficult school situations related to symptoms and consultation.

Methods: The subjects were 13 professionals with regular contact with children through their work, personal relationships or both. Subjects were identified using snowball sampling. Data was collected through semi-structured interviews. The interview guide was “elements of SST necessary to help children with psychosomatic and neurotic disorders to explain their symptoms with their classmates, teachers and parents.” Analysis was conducted using induction. The study was reviewed and approved by the ethics review committee of the affiliated institution.

Results: The subjects were six nurses, four elementary school teachers and three nursing school teachers. The mean period of employment was 22.3±11.7 years. After inductive analysis, the 10 elements shown in Table1 were extracted.

Discussion: It is necessary to include these 10 elements in SST when aiding psychosomatic and neurotic children with discussing their symptoms or therapies in a school setting.