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Imagine you are supposed to receive 1.0 milligrams of a drug, and a barely visible decimal point causes the pharmacist to deliver 10 milligrams instead. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Errors and irregularities in IV drug preparation can have a broad range of consequences ranging from harmless to serious to fatal.
Since the early 70s more and more studies of the quantity of parenteral medication errors have been published30. Anywhere RN™ creates a flexible medication administration process that positively impacts nursing and patient safety.
The latest release of Anywhere RN software features enhanced privacy for patient data and more configurable options to improve patient safety and assist in meeting regulatory requirements. Crowding at the ADCs takes valuable time away from nurses and also limits access for pharmacy. By reducing the number of trips to and from the ADC, Anywhere RN helps reduce the potential for interruptions that can lead to medication errors in nursing, and it frees up more time for patient care. Fewer lines at the cabinet during the medication pass process increases nurse satisfaction. When used with Omnicell's Savvy™ mobile medication workstation, nurses can securely retrieve medications for multiple patients in one trip to the cabinet. Clipping is a handy way to collect and organize the most important slides from a presentation. Following standard procedure, the nurse who'd processed the doctor's order had also sent the pharmacist a copy of her transcription.
This transcription error is a good example of how illegible handwriting causes problems and why at least two professionals-a nurse and a pharmacist-must interpret every drug order. Luckily, the pharmacist caught this transcription error before the patient received twice the prescribed amount of Rocephin. The National Patient Safety Agency in the United Kingdom has compiled figures showing the type of medication error incidents that actually occur. It is a web-based application that lets nurses remotely perform medication management tasks away from the automated dispensing cabinet (ADC). Nurses often feel rushed if others are waiting in line, which causes stress and can increase the potential for medication errors. Nurse interrupted: South Jersey Hospital uses technology to reduce disruptions, avoid errors. For example, the nurse may forward a transcription of the order-but not the original order-to the pharmacy. Evidence-based management is particularly important in the area of quality improvement (QI) [1] in healthcare because of the need to develop and assess practices for better process and outcome measurable.There are many popular QI tools such as Six Sigma and Lean systems. Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center. A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%. A critical review of the research literature on Six Sigma, Lean and StuderGroup's hardwiring excellence in the United States: The need to demonstrate and communicate the effectiveness of transformation strategies in healthcare. Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.
Facilitating process changes in meal delivery and radiological testing to improve inpatient insulin timing using six sigma method.


Improving timeliness and efficiency in the referral process for safety net providers: Application of the Lean Six Sigma methodology. Wrong transcription and incorrect labeling can both lead to much more severe consequences than simply a wrong drug dose. This most often occurs in critical care areas of the hospital, such as the operating room, emergency department, and intensive care unit.
Aim: To use elements of a six sigma model to reduce non-productive time in Gastro Intestine Surgery OT. Using Lean Six Sigma Tools to Compare INR Measurements from Different Laboratories within a Community.
These errors can lead to a mix-up of patients or a mix-up of the prescribed drug, to a wrong application route, a wrong time for application, omission of the drug or even to side effects or infections. It was found that in more than 4,107 cases (28.9 % of total) the most frequent medication error was wrong dose, strength or frequency of the prescribed drug. It focuses on the reduction of NPT between Patient In time and Induction Begin time, Induction End time and Incision In time, Patient Out time and OT Readiness Time. Lean Six Sigma (LSS) [3] is a philosophy and set of management techniques focused on continuous "eliminating waste" so that every process, task or work action is made "value adding" as viewed from customer.
Similarly, a problem might come up if a nurse doesn't double-check the pharmacist's work when he interprets the order and prepares a computerized MAR. Mapping involves clarifying the customer base, listing the process steps, identifying value-add steps, and reworking the process, so the workflow is without interruption. Measure, Analyze, Implement & Control) model, business case, value analysis, brain storming, FMEA (Failure Mode & Effect Analysis), RPN (Risk Priority Number) calculation identified causes and solutions. Although, there are many QI tools in healthcare management, LSS are two new and popular tools to be used in the healthcare industry. It is a high priority service area from the management point of view, which requires adequate attention and willingness to improve efficiency for better returns on investment.
Overall bottom line improvement was 4.8CR for the study period by bringing efficiency in the system.
The objective of the study includes increasing the efficiency of the OT utilization in order to avoid the NPT in OT, improve efficiency and reduce related financial loss. The study was carried out during the period of 6 months from July to December 2010.The Define, Measure, Analysis, Improve and Control (DMAIC) [4] method was used to achieve the objectives of the study.
An affinity diagram [9] was drawn along with Ishikawa [10] (fish bone diagram) for representation of priorities areas. Failure Mode and Effects Analysis (FMEA) [11] was conducted based on risk priority number (RPN). Mapping of action items with a timeline was charted after pooling in all resources for corrective and preventive measures.Sample sizeRetrospective data of 44 cases were analyzed to know the NPT.
37 min was the average turnaround time (TAT) for the next case to be taken in the theatre after the previous case is over, hence the total NPT in a theater was approximately 60 min.During the measure phase, the analysis of the existing system with various measurement techniques for defects and levels of perfection was done. This step helped in understanding whether any progress was achieved when process improvements were implemented.
Value analysis of the value stream analysis was done, 27 were found to be value added activity, 66 were adjudged as operational value-add and 6 were nonvalue added, which were removed during the implementation phase.Analyze phase was undertaken to determine any disparity that may exist in the goals set and the current performance levels achieved. The understanding of the relationship between cause and the effect was necessary to bring about any improvements, if needed.
Brainstorming session was carried out and all the causes were listed in the affinity diagram.


Creative development of processes [13] and tools [14] brought about a new lease on life for the organization's processes and took them nearer to the organizational objectives. Various project management and planning tools were used to implement the new techniques and processes.
Management support was also be built up for logistical response and sustaining the achievement of the long-term goals of the project. Control phase is the last step in the DMAIC method [6] and all efforts were made to maintain the motivation levels and engagement of all participants.Data collected were statistically analyzed and it was hypothesized that there is no difference between new and old NPTs.
The target sigma was set as two for all NPTs and the process sigma level for the three NPTs were below one sigma.
With the use of LSS, all factors such as reduction of start time delays and decrease TAT between surgical cases were targeted.
One of the studies also estimated the cost savings to the range of $350,000 to $500,000 annually. There were similar studies on TAT at laboratory, radiology, lack of available beds, registration and discharge process and staffing patterns. Some of studies estimated the cost savings and revenue generated ranging between $34,000 by reducing the staffing, a 49% decrease in claims costs and increased revenue of $18,000 using LSS application in healthcare.During our study, with the current implementation of LSS, the organization were able to provide back up for the accessories which have multiple uses, provided a better TAT and bed availability in postoperative recovery for faster shifting of operated patients, TAT also improved by segregating the cases as day care surgeries and tracking each case.
The implementation of proper central scheduling at OT which was made transparent and real time also helped significantly. An obvious benefit because of adequate monitoring during the study period was an improvement of the discharge process by alerting and marking the patients and finishing all necessary formalities related to discharge on the previous day basis implemented.The overall discipline in OT improved during the study period.
The wheeling of patient became smoother with patients being trolleyed at holding bay before time, the induction to wheeling time reduced to 3 min, owing to the ready availability of surgeons and more so senior surgeons, the time between the end of induction and incision time also reduced by 9 min.
The trained cleaning crew was ready to clean up the waste, spills (if any) and major surfaces as soon as the patient was wheeled out of the theater.
It leads to an overall increase of 102 cases during the control phase when compared to the similar months in last year.There was an evident direct and indirect cost savings with application of LSS.
There was savings on overheads, improved storage of accessories, and lesser cancellation because of proper scheduling and follow-up with patients 48 h in advance plus the opportunity to do more cases. Needless to mention that there was improved internal customer satisfaction and better patient response during the study period. The resource allocation of providing the accessories required for surgical procedures especially for laparoscopic cases took some time, since it was routed through purchase and technical committee. Overall gain from the implementation of the study was possible because of providing back up for the accessories which have multiple uses, ready availability of the cleaning crew, transparent central OT scheduling, monitoring postponement and cancellation of surgeries and its evaluation, preemptively working on making postoperative beds available for the surgical cases.
During this period, owing to engagement of key stakeholders and management, the overall discipline and day care surgeries also improved.There was an evident benefit of $80,000 by making the system more efficient and performing more surgical cases. Top management gave high priority in reducing the cost and better utilization of theatre during the study period.
Subramaniam (QIMPRO) who hand holded the project team at AIMS at each step during the study period. Institution is also obliged to National Board for Quality Promotion, Quality Council of India for designing National Development Program and including AIMS as one of the institution and to QIMPRO and Mr.



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