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  Most popular articles (Since August 20, 2018)

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Laboratory quality improvement: Act or perish
Rateesh Sareen, Menka Kapil, Gajendra Nath Gupta
January-June 2019, 1(1):2-6
The increasingly dominant role of laboratory medicine in clinical decision-making and the simultaneous pressure on cost containment have led to careful evaluation and identification of preventable causes of errors in total testing process of laboratory analyte. The patient-centric health-care delivery system mandates the need to formulate policies and procedures based on international guidelines to minimize errors of laboratory professionals or nonlaboratory operators. The paper summarizes various areas of laboratory that are prone to errors so that the laboratory can redesign the system and make it resistant to errors unknowingly committed by health-care professionals.
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Prescription audit study from a tertiary care private hospital in Kolkata, India
Subhrojyoti Bhowmick, Shubham Jana, Saksham Parolia, Anupam Das, Protim Saren
January-June 2019, 1(1):13-18
Introduction: Prescription writing is an important aspect of safe medication practices. Prescriptions should adhere to best practices mentioned in the World Health Organization guidelines and the National Accreditation Board for Hospitals and Healthcare Providers guidelines. Aim: Evidence about prescription audit study conducted in developing countries like India is scarce, especially from the Eastern part of the country. Hence, the current prescription audit study was conducted in a tertiary care private hospital in Eastern India in the city of Kolkata. Materials and Methods: This study presents an assessment of the quality of prescribing practice in a tertiary care private hospital in Kolkata. Six thousand four hundred and six medicine cards (6406) of inpatients were prospectively analyzed for the duration of 6 months. Results: The audit revealed that only 69.24% of medicine cards had captured drug allergy, 99.53% had mentioned the route of administration, 99.85% had dose strength, 99.89% had mentioned the frequency of dose, and only 75.35% had mentioned the indication/diagnosis of patients. Surprisingly, 90.75% of medicine cards had an error-prone abbreviation which was an issue of major concern. Conclusions: The audit report was shared with the clinicians every month along with regular training of good prescribing practices, which improved the quality of prescribing practice. Regular prescription audit followed by dedicated clinical pharmacology team along with constant communication with clinicians can improve the quality of prescriptions in long run.
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Level of compliance to quality standards and staff attitude toward adopted practices in a specialty hospital
Surendra Kumar, Rajesh Kumar Grover
January-June 2019, 1(1):7-12
Introduction and Aim: NABH accreditation is seen as an assurance towards quality services and patient safety. We conducted study at a 150 bedded, NABH non-accredited, speciality hospital to identify extent of compliance of practices and policies of the hospital with NABH standards for patient centric activities and to study staff attitude towards practices followed. Materials and Methods: In 5 patient-centered activities chapters of the NABH standards, 61 standards with 403 observable elements were identified applicable to the hospital. The prevalent practices of the staff were observed (each element observed 50 times), relevant records checked to assess compliance with the NABH standards. A sample population of staff (doctors, nurses, technicians) was randomly selected and interviewed on a set of 9 questions to assess awareness of hospital policies and rationale of the practices followed. Results: Compliance to NABH documentation requirements was 37%. Where predefined policies were present, a highly uniform practice (uniform on ≥80% observations) was observed for 96% elements, high uniformity was observed for only 15% elements in cases where no predefined policies were present. The hospital performed best on standards in 'Hospital Infection Control', where documentary compliance was 60%; and 78% elements complied at ≥80% observations with 63% complying at all observed times. The compliance rate was least for standards in 'Patient Rights and Education' where documentations compliance was 14% and only 37% elements complied at ≥80% observed times. Only 50% of the sampled population was aware of all departmental policies while 12% was completely ignorant of the policies. Practices of most of the care providers, 76%, was based on learning by seeing others doing the job, while some (18%) followed verbal instructions. Deviations from established practices were common and gave rise to near misses (66% responders). Most of the care providers, 85%, did not report such events; events not resulting in obvious harm to the patient and consideration that the event was not because of one's own fault were major factors for underreporting. Introduction of checklists and regular training was recognised as a means to prevent such events. Conclusion: The hospital needs to formulate more policies and SOPs. Training and sensitisation of staff regarding work protocols and safety measures were infrequent and inadequate.
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Analysis of incidents of fall in the patients receiving home healthcare services
Ridhima Pahwa, Punitha Singh, Gagan Kapoor, Gaurav Thukral, Prativa Talukdar, PC Joseph
July-December 2019, 1(2):21-25
Background: Incidents of fall remains the major cause of accidental and unintended injury in health care setups. Caring for patients at homecare setting comes with its own challenges and concerns. Methods: The incidents of fall reported over past 18 months in patients availing home care services from Healthcare at home from February 2018 to August 2019 was analysed to identify various risk factors involved in fall and suggestions for fall prevention were laid out in the study. Results: The fall percentage reported was 1.29% of patients served by HCAH during this tenure. The incident of fall was higher in rehabilitation services and lower in nursing services. The results show that prevalence of falling was higher among women than men between the age of 65-84 years. The highest number of falls was reported in patients suffering from neuro disorders, most of the incidents resulted due to external factors where more emphasis needs to be given on creating safe environment in the patient's home. Conclusion: Providing clinical care at home environment even makes it more difficult to control certain factors such as adequate space in the room for safe mobilization or unavailability of grab bars or presence of slippery floors or poor lightening are the majorly contributing to incidents like falls. Thus, identifying underlying risk while admitting the patient in homecare becomes the primary responsibility of the care provider.
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Improvement of platelet supply by the project research quality control circle and win-win team model in a hematological department
Qianli Jiang, Chengpu Yu, Leyi Chen, Xiaorui Cui, Yanyan Chai, Zhengyuan Wang, Quanfeng Chen, Maoyu Qin, Maoyuan Wang, Wenyuan Li, Tingfang Liu
July-December 2019, 1(2):32-38
Objective: Platelet is a crucial medical resource to ensure the quality and patient safety in healthcare. A project research Quality Control Circle (prQCC) was applied to this platelet shortage challenge in a level 3 Grade A hospital of South China. Materials and Methods: (1) A prQCC team was established based on the win-win team model. (2) By system diagram analyzing, the prQCC focused on improving the donation of the society. (3) The differences between regular donors and ordinary volunteers were analyzed using questionnaires, and four strategies were integrated and implemented according to the analysis of the requirements from donors and volunteers. (4) The platelet supply as well as tangible and intangible achievements were collected and evaluated. Results: More donors were recruited, including 313 ordinary volunteers and 76 regular donors, 226 units of platelets were donated directly. The platelet supply in the department of hematology has increased to 121.95% (from 4792 to 5844 units) versus 105.56% (from 9488.5 to 10016 units) in the hospital. Each participant of this prQCC benefited from tangible and intangible achievements, with a closed win-win loop formed. Conclusions: The prQCC is an efficient tool to improve platelet supply; and the win-win team model is also potentially useful in other areas of quality in healthcare, and thereafter worth spreading.
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Caregiver satisfaction with quality of care in the pediatric medical ward of a large hospital in Botswana
Mbaakanyi Masikara, Alemayehu Mekonnen Gezmu, Merrian Brooks, Lesego Gabaitiri, Tonya Arscott-Mills
July-December 2019, 1(2):26-31
Context: Few studies in developing settings seek to determine caregivers' level of satisfaction with medical services provided for their children. High-quality medical care is associated with improved health outcomes and higher health-care utilization. Aims: We sought to understand caregiver satisfaction in the pediatric ward of a large hospital in Botswana. Settings and Design: A cross-sectional, descriptive survey was conducted in the pediatrics medical ward at a referral hospital in Gaborone, Botswana, between September and October 2017. Subjects and Methods: A cross-sectional survey was conducted on caregivers admitted with their children in the pediatric ward of a large multispecialty hospital in Botswana. A total of 250 caregivers took a modified Service Quality Instrument from September to October 2017. The quality service instrument provides expectation and perception data in two subscales and assesses the difference between expectation and perception score, or gap score, for five dimensions of medical care. Statistical Analysis Used: All data were analyzed using Statistical Package for Social Science software. Results: The mean gap scores for the cohort were all negative, showing poor satisfaction and discrepancies between expectations and perceptions. The overall mean gap score was at − 0.315 (P < 0.001). The gap scores were as follows: for tangibles, –0.372; reliability, –0.1656; responsiveness, –0.210; assurance, −0.137; and empathy, −0.198. There was a statistically significant difference between the mean gap scores of caregivers in the oncology (−0.08) and medical cohort (−0.35) (P < 0.005). Conclusions: Caregivers in the hospital with their children were dissatisfied with the quality of care their children received in each quality domain measured. Hospital and government leaders of growing health systems have an opportunity to create environments and communication that are responsive to the needs of caregivers who are partners in the care of children.
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Quality and patient safety – A global agenda
Pawan Kapoor
January-June 2019, 1(1):1-1
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