Risk management systems for health care and safety development on transplantation: a review and a proposal

Thermodynamic properties and switching dynamics of perpendicular shape anisotropy MRAM

The power consumption of modern random access memory (RAM) has been a motivation for the development of low-power non-volatile magnetic RAM (MRAM). Based on a CoFeB/MgO magnetic tunnel junction, MRAM must satisfy high thermal stability and a low writing current while being scaled down to a sub-20 nm size to compete with the densities of current RAM technology. A recent development has been to exploit perpendicular shape anisotropy along the easy axis by creating tower structures, with the free layers' thickness (along the easy axis) being larger than its width. Here we use an atomistic model to explore the temperature dependent properties of thin cylindrical MRAM towers of 5 nm diameter while scaling down the free layer from 48 to 8 nm thick. We find thermal fluctuations are a significant driving force for the switching mechanism at operational temperatures by analysing the switching field distribution from hysteresis data. We find that a reduction of the free layer thickness below 18 nm rapidly loses shape anisotropy, and consequently stability, even at 0 K. Additionally, there is a change in the switching mechanism as the free layer is reduced to 8 nm. Coherent rotation is observed for the 8 nm free layer, while all taller towers demonstrate incoherent rotation via a propagated domain wall.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study

OBJECTIVE

This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts.

METHODS

This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis.

RESULTS

A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories.

CONCLUSIONS

The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

Outcomes of Effective Integration of Clinical Risk Management Into Health Care From Nurses' Viewpoints: A Qualitative Study

The aim of this study was to explore nurses' experiences and viewpoints about the outcomes of effective integration of clinical risk management (CRM) into health care. This qualitative study was conducted using purposive sampling and semistructured interviews with 19 nurses from three hospitals affiliated with a large medical university. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. Data analysis reflected the following concepts: improving the quality of services and promoting health, preserving and protecting patient safety, increasing satisfaction, improving staff morale, and improving organizational awareness and vigilance. According to the results, CRM with its positive outcomes can help the development of a patient-oriented culture. The results can be a starting point for further quantitative and qualitative research to explore other strategies, potentials, and capacities of quality improvement activities such as CRM in other contexts and cultures.

Failure mode and effect analysis: improving intensive care unit risk management processes

Purpose

Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran.

Design/methodology/approach

This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services – their frequency and severity – were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation.

Findings

Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures.

Practical implications

Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function.

Originality/value

Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.