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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 2 | Issue 3
Page Nos. 53-84

Online since Wednesday, August 14, 2019

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ORIGINAL RESEARCH  

Assessing knowledge and compliance of patient identification methods in a specialized hospital in Saudi Arabia p. 53
Fadwa Abu Mostafa, Amal Saadallah, Hadi El Barazi, Hanan Alghammas
DOI:10.4103/JQSH.JQSH_27_18  
Background: Patient misidentification prevails in daily practice and remains a critical issue in health care. Being knowledgeable about how to accurately identify patients and comply with identification processes is critical, particularly in countries where patients have similar names. A study was undertaken to examine the knowledge levels of and compliance with the patient safety goals and policies and procedures of the clinical and nonclinical staff. Materials and Methods: A cross-sectional survey and an observational audit design were used at a specialist and research hospital in the Saudi Arabia to assess knowledge levels and compliance rates of appropriate patient identification methods. Results: The majority of healthcare providers (n = 350, 87.1%) and almost half of non-healthcare providers (n = 186, 47.8%) reported high levels of knowledge of patient identification standards, including the need to use two patient identifiers. However, audit results revealed that health-care providers used two identifiers in only 33 observations (18%), with the majority (147 observations, 82%) of health-care providers checking the patient’s name only and not his/her medical record number. Conclusion: The results highlight the need for further attention to improper identification of patients, including understanding the causes and ways to enhance the translation of patient identification standard into practice.
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Understanding the nature, contributing factors, and corrective actions of medication administration errors: Insights from Saudi Arabia p. 58
Akram M Bashaireh, Mohammad S Jaran, Rania I Alobari, Salma M Al-khani
DOI:10.4103/JQSH.JQSH_28_18  
Background: Medication errors continue to be a global patient safety concern as they are associated with a negative impact on morbidity and mortality and health-care costs. Research in Middle Eastern countries has been limited and focused on reporting on the incidence, type, and contributing factors with limited knowledge on the preventability and severity of medication errors and the corrective action taken from the reported medication errors. Materials and Methods: A retrospective, descriptive study design was used with selected clinical units in one hospital in the Middle East to gain insight into the incidence, type, location, level of severity, and causes of medication administration errors (MAEs) and the corrective actions taken. Data collected between February 17, 2014 and August 30, 2015, in the organization’s reporting system were analyzed using descriptive statistics. Results: The most frequent types of MAEs reported were delayed administration (23%) and wrong dose (15%), occurring in the clinical units (65%), ambulatory settings (18%), the pediatric children cancer center (11%), and the surgery division (3%). The majority of MAEs were rated as no harm (184 errors, 69%) followed by temporary harm (80 errors, 30%), with two incidents with pediatric patients resulting in permanent functional harm and one incident with a pediatric patient resulting in death. The majority of factors contributing to the MAEs involved staff factors including failure to follow policies and procedures (86%) followed by inadequate communication (17%). The most common corrective action was no action (30%) followed by counseling the staff involved in the MAE (29%), sharing at a unit or departmental meeting (25%), and training and educating the staff (15%) as a result of the error. Conclusion: Our study results delineated the nature, contributing factors, and corrective actions taken associated with reported MAEs. Future research is required to examine and explore the nature of MAEs, contributing factors, corrective actions taken, and exploration and examination of the impact of efforts to enhance MAE reporting and learning systems in hospitals.
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Wait times for diagnosis and treatment of lung cancer: Experience of the medical oncology department of Hassan II University Hospital of Fez p. 65
Zineb Benbrahim, Othmane Zouiten, Kawthar Messoudi, Mariam Atassi, Lamiaa Amaadour, Karima Oualla, Samia Arifi, Samira ElFakir, Nawfel Mellas
DOI:10.4103/JQSH.JQSH_8_19  
Background: Lung cancer is a public health problem in Morocco. Multiple clinical practice guidelines recommend rapid evaluation of patients with suspected lung cancer. It is uncertain whether delays in diagnosis and management are correlated with outcomes. The objective of this study was to evaluate if these delays have any negative effect on outcomes. Methods: This retrospective study included 140 patients diagnosed with non-small cell lung cancer (NSCLC). It was conducted at the Medical Oncology Department of Fez from January 2016 to December 2017. We have studied many wait times and considered that: wait time to consult (WTC) is the delay from the first symptom to initial consultation, wait time to diagnosis (WTD) is the delay from initial consultation to diagnosis, wait time to referral (WTR) is the delay from diagnosis to referral to the oncologist, and wait time to treatment (WTT) is the time from referral to treatment initiation. Our analysis used Kaplan–Meier method to estimate the overall survival (OS). To compare the OS between wait time categories, we used the logrank test. Results: The median age was 59.46 years. The sex ratio was 6 men for 1 woman. The most common histological subtype was adenocarcinoma (58.6% of cases). Eighty-two percent of patients were diagnosed at stage IV. The median WTC was 240 days (range, 15–280 days), WTD was 45 days (13–65), WTR was 54 days (13–63), and WTT was 32 days (12–40). The only factor that was associated with a long WTD was long distance (> 60 km) to the hospital (p = 0.05). We found that short WTC, WTD, and WTR had better OS: 12 versus 3 months (p < 0.0001), 12 versus 4 months (p < 0.0001), and 14 versus 5 months (p < 0.0001), respectively. We found no difference in OS between short and long WTT. Conclusion: In our study, patients with lung cancer experience significant delays from development of symptoms to first treatment initiation. We found a clear association between survival and short delays from initial symptoms to consultation, from consultation to diagnosis, and from diagnosis to referral to the department of oncology.
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Awareness and occupational exposures to needlestick injuries among healthcare workers: A quantitative assessment in a Ghanaian Metropolis p. 70
Christian Obirikorang, Samuel K Opoku, Yaa Obirikorang, Emmanuel Acheampong, Joseph Yorke, Emmanuel T Donkoh, Chike Chidera, Davis Sarpong, Enoch O Anto, Razak Issahaku, Mark Appeaning, Christian Nelson, Emmanuella N Batu, Bright Amakwah, Evans A Asamoah, Beatrice Amoah, Bright O Afraine
DOI:10.4103/JQSH.JQSH_9_19  
Background: This study determined awareness and occupational exposures to needlestick injuries (NSIs) and its associated risk factors among healthcare workers (HCWs) in the Kumasi Metropolis, Ghana. Materials and Methods: A descriptive cross-sectional study was conducted among a total of 540 HCWs from three selected tertiary hospitals in the Kumasi Metropolis, Ghana. Data were collected using a structured questionnaire and analyzed. Results: All the study participants were aware of NSI and NSI-associated hepatitis B virus (HBV), hepatitis C virus, or human immunodeficiency virus (HIV) acquisition. Most of them (63.6%) were trained on the safety use of sharps devices and the majority of them preferred safety-engineered devices (79.8%). A greater proportion of the participants has had HBV vaccination (85.9%). The prevalence of NSIs was approximately 47%. NSIs were highly ranked to occur at patient’s bedside (28.5%) and clinical laboratories (24.6%). Handling of needles/sharp objects before usage (27.7%) and during usage (34.0%) ranked the second and first cause of NSIs among health workers, respectively. Compared with those with less than 5 years working experience, having worked at the health facility between 5 and 10 years (prevalence rate ration [PRR] = 2.07 [1.39–3.11], p = 0.0004), 11–15 years (PRR = 4.32 [2.14–8.73], p < 0.0001), and >15 years (PRR = 5.73 [2.40–13.70], p < 0.0001) were associated with increased events of NSI. Conclusion: Despite the high awareness of NSIs and its perceived risk of infection acquisition, the prevalence of NSIs was high among HCWs. There is, therefore, the need for employers to enforce the universal precaution practices, provide regular training and education, and ensure adherence of HCWs to safety precaution of needle usage disease.
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QUALITY IMPROVEMENT PROJECT Top

Improving door-to-antibiotic administration time in patients with fever and suspected chemotherapy-induced neutropenia: A tertiary care center experience Highly accessed article p. 78
Reem Al Sudairy, Mohsen Alzahrani, Mohammad Alkaiyat, Mona Alshami, Abdullah Yaqub, Maha Al Fayadh, Khaled Al-Surimi, Abdul Rahman Jazieh
DOI:10.4103/JQSH.JQSH_1_19  
Background: Chemotherapy-induced febrile neutropenia (FN) is a major cause of morbidity and mortality in cancer patients if not treated promptly. As we were facing considerable delays in the management of chemotherapy-induced febrile neutropenic patients in the Emergency Department (ED), we initiated an improvement project aiming for “door-to-antibiotic time” of 60 minutes or less for all patients with fever and suspected chemotherapy-induced neutropenia. Methods: A multidisciplinary team was established to work on the project. We used quality improvement tools for mapping the existing patient flow processes of patients with FN in the ED. Several proposed change ideas have been tested using the Model for Improvement. These change ideas include improving the triaging process, creating an electronic “chemotherapy alert caution” and order sets for physicians, and using the hot-line by nurses to call the pharmacy to expedite the process of preparation of antibiotics. Outcome and process measures were collected weekly and they were discussed thoroughly and analyzed by the team. Run charts were used to monitor the progress. Results: After six Plan-Do-Study-Act cycles, all process measures improved and ultimately the “door-to-antibiotic time” was achieved by reducing it from 255 minutes to 49 minutes. During project testing and implementation, the nursing staff skills improvement and education were taken into consideration as a balancing measure. Conclusion: In a six-month period, the project led to a timely administration of antibiotics for patients with FN in the ED. This improvement was sustained for more than two years after the project initiation.
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