Day 1 :
- Patient Safety | Healthcare | Errors in Patient Safety | Patient Safety & Nursing Education | Primary Healthcare
Session Introduction
Asma A Alhindi
Royal Hospital, Oman
Title: Monitoring of adverse drug reactions among hospitalized patients in a psychiatry hospital contribute to patient safety
Biography:
Asma Alhindi has done Clinical Pharmacist. She started as pharmacist with a Bachelor certificate in pharmacy at Oman medical college in 2011 then after six years qualified by a Master certificate in clinical pharmacy service development at Robert Gordon University Aberdeen Scotland. She has more than 10 years’ experience in Psychiatry tertiary Hospital Almasarra Hospital worked as team in ensuring safe use of medications and patient safety. She joined early this year to Royal hospital clinical pharmacy to continue providing care to the patients and work as team for more effective safe pharmaceutical practice. She is participating as focal point in WHO patient safety program in the hospital.
Abstract:
Background: An Adverse Drug Reaction (ADR) is undesirable effect of medications that occur during routine clinical use. Adverse drug reaction is a worldwide health problem affecting quality of patient safety in all healthcare settings. Psychiatric hospitals will not differ from other general hospital in experiencing adverse drug reactions due to psychotropic medications. Antidepressants, antipsychotics and mood stabilizers are the major psychotropic agents associated with ADR. Antidepressants and antipsychotics in many studies accounted for approximately 90% of all ADR. The incidence of ADR in hospitalized psychiatric patients is not only frequent, but also highly preventable
Objectives: The crucial objective of present study is to improve patient safety and compliance toward psychotropic medications and highlight the role of clinical pharmacist in ADR management. In addition, this study helps to create awareness about the importance of introducing hospital-based ADR reporting and analyzing system.
Research method: The research is an observational study for monitoring of adverse drug reactions related to psychotropic medications in a tertiary hospital. The study carried out in clinical pharmacy department in Almasarra Hospital and encompassed inpatients admitted in period between September 2020 and September 2021 and who were prescribed psychotropic medications. The outcome variables include assessment of ADR using monitoring scales for ADR. The software EXCEL is used for data collection and analysis.
Results: An initial result showed total of 506 patients was screened for ADR. At least one ADR has been reported in 235 patients among them 134 males and 92 females. There were 25 different types of ADR mostly metabolic syndromes and extrapyramidal side effects due to antipsychotic drugs. Assessment of causality, severity, and preventability showed that most of ADRs were unpreventable.
Conclusion: Developing an ADR internal reporting and analyzing system in a hospital can provide useful information and statistics regarding potential side effects associated with medications use.
Shaghayegh Rahmani
Islamic Azad University, Iran
Title: The emergency department trigger tool implementation
Biography:
Shaghayegh Rahmani has received her master in medicine during 2001- 2008, and her specialty in Emergency Medicine during 2015-2019 at Mashhad University. Currently, she is working as assistant Professor in Mashhad Islamic Azad University of Medical Sciences. She is the Executive Director of the Islamic Azad university journal; she is also the director of research and development center of University. Her research included a wide spectrum from patient safety to clinical and pathological researches.
Abstract:
Introduction: Trigger Tool (TT) was first designed by the Institute for Health Improvement. In 2009, a revised version of TT was developed for the emergency, surgery, pediatric and intensive care units. In this paper we share the executive experience of using Emergency Department Trigger Tool (EDTT) in our academic emergency department.
Method: This is a retrospective observational study using data from one month of visits to an academic, tertiary emergency department by patients aged ≥18 years (5600 records). We randomly based on random block method evaluated 100 records with at least 6 hours of hospital stay. In this study two review teams evaluated medical records. Each team consists of an experienced emergency medicine specialist and one Registered Nurse (RN) with great experience within emergency department care. Records not containing any triggers or containing only false positive triggers, i.e. triggers not indicating AEs were not forwarded to physicians for review but the outcome was documented and included in the analysis. The RNs also recorded demographics data, and entered all patients into the database. No time restriction existed in this review stage. A similar three-point Likert scale was used to investigate the preventability of the Adverse Events (AEs).
Results: In this study records of 100 patients were reviewed in a two stage review process. 39 patients (39%) were female and 61 ones (61%) were male. The difference in finding triggers was estimated about 5%. And overall Inter-Observer Agreement (IOA) was 0.828. From 100 evaluated cases, 82 files had triggers and 18 had not. Mean age of our patients was 62.1 ± 7.2 years. 142 triggers were identified in 82 files. Patients mean age was 62 ± 7.2 years. 19 medical records (23.1%) contained more than one trigger.
Conclusion: Using EDTT help health care providers to perform an accurate and comprehensive review to evaluate quality of care.
Keywords: Trigger tool, Emergency department, adverse event.
Sharmeen Ziarukh Jah
Manawan Hospital, Pakistan
Title: Patient participation and engagement in care process by implementing the patient safety caravan tool at Manawan hospital
Biography:
Sharmeen Ziarukh has completed her post-graduation MCPS and MRCGP (INT) in Family Medicine. She is working as Specialist in the Family Medicine department at Indus hospital, Manawan, Lahore since the past five years. She has additional responsibilities of Patient safety coordinator at Manawan hospital. She is assisting her patient safety team to achieve level 3 accreditation for WHO. She is also Chair of Clinical Ethics committee and CME Coordinator and is currently working on researches related to safe patient care.
Abstract:
Patient Safety is a discipline in healthcare which seeks to reduce the risks, errors and prevent harm that can occur to patients during the delivery of health care. It is considered to be under the domain of quality healthcare as viewed by many. Institute of Medicine (IOM) states that patient safety cannot be separated from healthcare quality delivery.
The Institute of Medicine (IOM) focuses on the importance of patient safety in healthcare. In the United States on an annual basis 1.5 million ADE’s take place. These ADE’s are costly but the most common cause of harm, which is preventable. These Medical errors contribute to about 98,000 deaths annually in the United States.
The data shares that in the United States hospitals, urinary tract infections (32%), surgical site infections (33%), pneumonia (15%) and bloodstream infections (14%) are some of the commonest HAI’s. They have also observed that between 2 and 5 falls per 1,000 patient-days take place in United States hospitals, categorizing falls as the biggest reason for ADE’s in hospitals. In addition, approximately 40,000-80,000 deaths occur yearly due to diagnostic errors. Similarly, surgical errors account for 40%-50% of adverse events in hospital in the United States.
The most important aspect of patient safety is the lack of involvement of patient in their own care. As early as 1977 the World Health Organization has advocated that patients should be involved in their healthcare decisions.
Importance of Research
Previously studies have shown that due to patient participation and engagement, better health outcomes can be attained which could be self-management, quality of life and cost effectiveness. Patient’s involvement in their healthcare decisions can prove to be a bridge between the healthcare system and patients experience as patients have more expertise on their own body and symptoms. This will eventually lead to, which improve better and safe care. The traditional medical model states that the physician has the primary role in decision-making but patient empowerment has shifted the ideology from physician centered care to patient centered care. Therefore, once the patient has all the skills, knowledge and attitude to influence and improve their quality of life, they are known as an empowered patient. This empowerment allows patients to shed their passive role and play an active part in the decision-making process about their health and quality of life.
Thus, a patient should be treated as an equal in healthcare in terms of rights and responsibilities. This self–care would also help to ease the economic constraints on the healthcare system. It is in the interest of patients and their families to take an interest in and to be responsible for their own safety. It is also the responsibility of healthcare providers and policymakers to keep the patients/families involved in their medical care.
Keywords: Patient safety, Culture, Patient engagement, Adverse drug reaction, Hospital acquired infection, Patient safety friendly hospital framework.
Shaghayegh Rahmani
Islamic Azad University, Iran
Title: Development of an emergency department trigger tool
Biography:
Shaghayegh Rahmani has received her master in medicine during 2001- 2008, and her specialty in Emergency Medicine during 2015-2019 at Mashhad University. Currently, she is working as assistant Professor in Mashhad Islamic Azad University of Medical Sciences. She is the Executive Director of the Islamic Azad university journal; she is also the director of research and development center of University. Her research included a wide spectrum from patient safety to clinical and pathological researches.
Abstract:
Objective: In this study we developed an Emergency Department Trigger Tool (EDTT) to identify adverse events in the Emergency Department (ED) for improving patient safety and quality improvement.
Method: This study was conducted under the supervision of Mashhad University of medical sciences as a four stages project: (1) a systematic review, (2) refining and automating of empiric triggers, (3) a modified Delphi process to identify a list of validated triggers by experts and (4) a final environmental data gathering to identify the best triggers.
Results: In this study, a systematic review of electronic resources was performed. There were no previous Persian equivalents about trigger tool. According to the keywords, 502 articles were found in PubMed, 100 articles in Google Scholar and 410 articles in Scopus database. Duplicated articles were removed. Based on the search for article references and similar ones, four articles were added to this number. A total of 1016 article titles were initially reviewed. Articles evaluations were performed by two independent researchers in two different locations on the same date and then the results were compared. In case of disagreement between them, the opinion of the third researcher was used. At this stage, 295 articles were selected. Interpreter reliability was high (0.82). 42 articles were included in the study for final analysis. The designed tool has 50 triggers in six groups. In the review of 100 cases in the emergency department, the number of triggers discovered was 1.2 one per patient file and 99 (79.8%) of these triggers, occurred because of medical errors.
Conclusion: In this study, we designed an Emergency Department Trigger Tool (EDTT) using a systematic review and Delphi method. The trigger tool obtained from this study can be used to assess high-risk situations and possible cases of emergency medical errors. One of the most important advantages of this tool compared to previous versions is considering high-risk conditions and not performing the correct action as a trigger and danger indicators.
Keywords: Emergency department, Trigger tool, Patient safety, Medical error.