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Alemu W, Cimiotti JP. Meta-Analysis of Medication Administration Errors in African Hospitals. J Healthc Qual 2023; 45:233-241. [PMID: 37276257 DOI: 10.1097/jhq.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT The incidence of medication administration errors (MAEs) and associated patient harm continue to plague hospitals worldwide. Moreover, there is a lack of evidence to address this problem, especially in Africa. This research synthesis was intended to provide current evidence to decrease the incidence of MAEs in Africa. Standardized search criteria were used to identify primary studies that reported the incidence and/or predictors of MAEs in Africa. Included studies met specifications and were validated with a quality-appraisal tool. The pooled incidence of MAEs in African hospitals was estimated to be 0.56 (CI: 0.4324-0.6770) with a 0.13-0.93 prediction interval. The primary estimates were highly heterogeneous. Most MAEs are explained by system failure and patient factors. The contribution of system factors can be minimized through adequate and ongoing training of nurses on the aspects of safe medication administration. In addition, ensuring the availability of drug use guidelines in hospitals, and minimizing disruptions during the medication process can decrease the incidence of MAEs in Africa.
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Lim NK, Kim S, Hee Yoon J, Choi KH. Association between the participation of the plastic surgery department and qualitative prognoses in severe trauma patients: A retrospective observational study. Medicine (Baltimore) 2022; 101:e32387. [PMID: 36595792 PMCID: PMC9794290 DOI: 10.1097/md.0000000000032387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Catastrophic incidents would necessitate the intervention of multiple specializations with plastic surgery (PS) as an indispensable area of expertise. In view of PS, prognostic assessment of trauma patients should be focused on the qualitative value rather than mortality because plastic surgeons rarely handled patients' vital signs in actual. Thus, we explored the association between the involvement of the PS department and qualitative prognoses for severe trauma patients. From November 2014 to December 2019, we enrolled total 529 trauma patients with an injury severity score (ISS) over 15 points. We set the prognostic factors that the rate of admission in intensive care unit (ICU), total or ICU duration of hospitalization, post-discharge progress and disability diagnosis which were regarded as qualitative prognoses. The analysis was performed with logistic regression analysis or regression analysis adjusted for age, sex, past medical history, cause of trauma, and frequency of operation. Among total of 529 patients, 290 patients in PS group and 239 patients in non-PS group were analyzed. In both groups, the under-65-year ages and male patients were significantly predominant. The rate of going home showed 2.082 times higher in PS group than non-PS group after adjusting for covariates, while there was no significant difference in diagnosis of disability. Meanwhile, overall prognoses were highly correlated with either higher ISS or lower Glasgow Coma Scale (GCS). In conclusion, higher severity generally affected to the severe trauma patient's prognoses, and the PS treatment only contributes to discharge disposition to home.
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Affiliation(s)
- Nam Kyu Lim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Chungnam, Republic of Korea
- *Correspondence: Nam Kyu Lim, Department of Plastic and Reconstructive surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea (e-mail: /)
| | - Sungyeon Kim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
| | - Jae Hee Yoon
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
| | - Kyung-Hwa Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Chungnam, Republic of Korea
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Hakkenbrak NAG, Mikdad SY, Zuidema WP, Halm JA, Schoonmade LJ, Reijnders UJL, Bloemers FW, Giannakopoulos GF. Preventable death in trauma: A systematic review on definition and classification. Injury 2021; 52:2768-2777. [PMID: 34389167 DOI: 10.1016/j.injury.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Trauma-related preventable death (TRPD) has been used to assess the management and quality of trauma care worldwide. However, due to differences in terminology and application, the definition of TRPD lacks validity. The aim of this systematic review is to present an overview of current literature and establish a designated definition of TRPD to improve the assessment of quality of trauma care. METHODS A search was conducted in PubMed, Embase, the Cochrane Library and the Web of Science Core Collection. Including studies regarding TRPD, published between January 1, 1990, and April 6, 2021. Studies were assessed on the use of a definition of TRPD, injury severity scoring tool and panel review. RESULTS In total, 3,614 articles were identified, 68 were selected for analysis. The definition of TRPD was divided in four categories: I. Clinical definition based on panel review or expert opinion (TRPD, trauma-related potentially preventable death, trauma-related non-preventable death), II. An algorithm (injury severity score (ISS), trauma and injury severity score (TRISS), probability of survival (Ps)), III. Clinical definition completed with an algorithm, IV. Other. Almost 85% of the articles used a clinical definition in some extend; solely clinical up to an additional algorithm. A total of 27 studies used injury severity scoring tools of which the ISS and TRISS were the most frequently reported algorithms. Over 77% of the panels included trauma surgeons, 90% included other specialist; 61% emergency medicine physicians, 46% forensic pathologists and 43% nurses. CONCLUSION The definition of TRPD is not unambiguous in literature and should be based on a clinical definition completed with a trauma prediction algorithm such as the TRISS. TRPD panels should include a trauma surgeon, anesthesiologist, emergency physician, neurologist, and forensic pathologist.
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Affiliation(s)
- N A G Hakkenbrak
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands.
| | - S Y Mikdad
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - W P Zuidema
- Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - U J L Reijnders
- Department of Forensic Medicine, Public Health Service of Amsterdam, the Netherlands
| | - F W Bloemers
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - G F Giannakopoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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Zhang GX, Chen KJ, Zhu HT, Lin AL, Liu ZH, Liu LC, Ji R, Chan FSY, Fan JKM. Preventable Deaths in Multiple Trauma Patients: The Importance of Auditing and Continuous Quality Improvement. World J Surg 2021; 44:1835-1843. [PMID: 32052106 DOI: 10.1007/s00268-020-05423-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management errors during pre-hospital care, triage process and resuscitation have been widely reported as the major source of preventable and potentially preventable deaths in multiple trauma patients. Common tools for defining whether it is a preventable, potentially preventable or non-preventable death include the Advanced Trauma Life Support (ATLS®) clinical guideline, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS). Therefore, these surrogated scores were utilized in reviewing the study's trauma services. METHODS Trauma data were prospectively collected and retrospectively reviewed from January 1, 2018, to December 31, 2018. All cases of trauma death were discussed and audited by the Hospital Trauma Committee on a regular basis. Standardized form was used to document the patient's management flow and details in every case during the meeting, and the final verdict (whether death was preventable or not) was agreed and signed by every member of the team. The reasons for the death of the patients were further classified into severe injuries, inappropriate/delayed examination, inappropriate/delayed treatment, wrong decision, insufficient supervision/guidance or lack of appropriate guidance. RESULTS A total of 1913 trauma patients were admitted during the study period, 82 of whom were identified as major trauma (either ISS > 15 or trauma team was activated). Among the 82 patients with major trauma, eight were trauma-related deaths, one of which was considered a preventable death and the other 7 were considered unpreventable. The decision from the hospital's performance improvement and patient safety program indicates that for every trauma patient, basic life support principles must be followed in the course of primary investigations for bedside trauma series X-ray (chest and pelvis) and FAST scan in the resuscitation room by a person who meets the criteria for trauma team activation recommended by ATLS®. CONCLUSION Mechanisms to rectify errors in the management of multiple trauma patients are essential for improving the quality of trauma care. Regular auditing in the trauma service is one of the most important parts of performance improvement and patient safety program, and it should be well established by every major trauma center in Mainland China. It can enhance the trauma management processes, decision-making skills and practical skills, thereby continuously improving quality and reducing mortality of this group of patients.
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Affiliation(s)
- Gui-Xi Zhang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ke-Jin Chen
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hong-Tao Zhu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ai-Ling Lin
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhong-Hui Liu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li-Chang Liu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ren Ji
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fion Siu Yin Chan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam Road, Hong Kong Special Administrative Region, China
| | - Joe King Man Fan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. .,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam Road, Hong Kong Special Administrative Region, China.
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Chu Z, Zhang W, You Q, Yao X, Liu T, Liu G, Zhang G, Gu X, Ma Z, Jin W. A Separation‐Sensing Membrane Performing Precise Real‐Time Serum Analysis During Blood Drawing. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202008241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zhenyu Chu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Wei Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Qiannan You
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Xiaoyue Yao
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Tao Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Gongping Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Guangru Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Xiaoping Gu
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Zhengliang Ma
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Wanqin Jin
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
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Chu Z, Zhang W, You Q, Yao X, Liu T, Liu G, Zhang G, Gu X, Ma Z, Jin W. A Separation‐Sensing Membrane Performing Precise Real‐Time Serum Analysis During Blood Drawing. Angew Chem Int Ed Engl 2020; 59:18701-18708. [PMID: 32648353 DOI: 10.1002/anie.202008241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Zhenyu Chu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Wei Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Qiannan You
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Xiaoyue Yao
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Tao Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Gongping Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Guangru Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
| | - Xiaoping Gu
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Zhengliang Ma
- Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing 210008 P. R. China
| | - Wanqin Jin
- State Key Laboratory of Materials-Oriented Chemical Engineering College of Chemical Engineering Nanjing Tech University NO.30 Puzhu Road(S) Nanjing 211816 China
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