Medication error reporting nursing care quality engineering,treatment options for diabetes insipidus quizlet,how to treat swollen feet postpartum - Reviews

We often note here that quality improvement in hospitals seems excruciatingly slow to happen, and engaged patients and families need to keep their eyes wide open, because sometimes a fix doesn’t require being a genius. We’re in our 13th year after To Err, yet this morning SPM member Paul Bearman spotted this article by Maura Lerner in the Minneapolis Star Tribune and posted a note on our member listserv. What I love about the story is how intelligent change can be so wonderfully effective.   A small tweak reversed critical failures in discharge prescribing.
He and his colleagues decided to do a spot-check of 37 patients who were discharged from the hospital to nursing homes over three months in 2008 and 2009. The most common problems: Hospital physicians had prescribed the wrong doses, duplicate medications or omitted medications. The project worked so well, Thompson said, that some doctors now call the pharmacist before they write the discharge orders. Share the Star Tribune article with your hospital (and nursing home’s) pharmacy staff.
I personally know of two cases in my own family, in the past year, where medications were overlooked or wrong at discharge. Kudos to Bruce Thompson and team at Hennepin County Medical Center – and to all the people there who gladly adopted the change.
The doctor’s original thought is still, in a way, being inspected by the pharmacist before the order is being written.
I hope that the pharmacists aren’t continually finding and fixing the same problems, whether before or after order writing. That pharmacist inspection step is going to be prone to failure, before or after order writing, since 100% human inspection is never 100% effective.
I appreciate the efforts being made in hospitals, but what about the walking wounded in the clinics. Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual's health. For the time being, Belgium remains out of the international markets' sights, for as far as the government can manage a sustainable budget balance in the following three years. There is no doubt that the remedy will be a mix of savings in government expenditure, efficient structural reform and looking for new sources of income.
For example, reduced refunds of medical treatment or hospital activities of which the actual expenses do increase annually. But also for example due to the reduced offer in clinical scientific trials financed by the industry. Secondly, economic crises reduce the demand, and therefore also the care consumption, resulting in stagnation of medical activities and therefore hospital income. The man in the street maintains a tight hold on his purse and medical care is pushed to the side-lines.
Crisis and unrest, fed further by an often ruthless press, causes people to become more moody, uneasy, impatient and even aggressive. Social values, such as tolerance and social solidarity which we perceive as acquired, threaten to move towards the "Me First"-feeling. Yet the UZ Brussel (hospital) manages to hold its pose in the midst of all these social challenges.
The UZ Brussel has reached comprehensive and certain stabilization after a period of clear growth.
In this report, you will find excerpts of the numerous initiatives that were taken and realised in 2011. Comparative surveys with other hospitals confirm this, such as the reputation survey carried out by Test-Aankoop midway through 2011. The patient is largely happy (UZ Brussel in top-three), the referring doctors are largely happy (UZ Brussel in top-two), the employees are working in a 'good' environment (UZ Brussel is Top-Employer), and scientific production (along with the faculty of Medicine and Pharmacy) continue to increase. The UZ Brussel is financially and structurally healthy and the operating results remain positive. Because we know very well it is the absolute treasure trove of employees that eventually made all of this possible.
We invite you to page through this annual report and to remember that behind every project, every development, every pleased patient, there are people who made this possible. In the postscript, you will find some of our answers to the - undoubtedly numerous - challenges we will be facing. We did not try and achieve a complete overview with this annual report, but we want to give you an idea of the most important accomplishments and changes in 2011. In 2011, 51,601 patients were hospitalised in total (classic and day-hospitalisation), or 1.4 % more than the year before.
The substantial increase of planned classic surveys were realised mainly by the services pneumology, abdominal and paediatric surgery, and the new diabetes clinic.
The number of emergency admissions dropped slightly by 1.1 %, but the emergency services a€“ our country's second largest established emergency service a€“ continued with 48 % of the patients to ensure a large through-flow to other hospital services. The number of day hospital admissions (excluding mini-forfaits) remained stable at 22,669 compared to 22,673 in 2010.
An increase in day hospital admissions was however noticeable in certain sections: Paediatrics, ear-, nose- and throat surgery, cardiology, abdominal and paediatric surgery, obstetrics and prenatal care. The number of consultations (excluding ER) increased from 274,032 in 2010 to 277,041 in 2011, an increase of 1.1 %. In absolute numbers, the following sections booked more consultations: paediatrics, obstetrics and prenatal care, once again the diabetes clinic, and ear, nose and throat care.
The number of technical referrals (excluding operating room and excluding clinical biology) amounted to 874,625 in 2011. The number of high care (chronic and acute) dialysis increased by 7 % from 12,138 to 12,984 in the nephrology section.
The number of radio-therapeutic treatments increased by 14.5 % from 1,272 to 1,457, of which 1,110 were carried out in the UZ Brussel, and 347 in the antenna in the ASZ Aalst. The number of pick-ups in the Centre for Reproductive Care (CRC) increased by 4.2 % (from 4,761 to 4,959). The CRC-activities in Kuwait in cooperation with the Royal Hayat Hospital are not included in the figures. The number of conventional patients in the diabetes clinic increased by 15.2 % (from 2,710 to 3,123). The UZ Brussel has booked enormous development, growth, and increase in image since its start in 1977.
In 2007, the year that it existed 30 years, a long-term process of change started that must result in a totally upgraded hospital in 2021.
The past 10 years, the company, its care, the patients and the care providers changed in the most divergent areas and the UZ Brussel keep this meticulously in mind. The UZ Brussel starts with several large building projects expanding and reorganizing the existing hospital into a modern, logic hospital environment that complies with the needs of the patients and care providers of today and tomorrow. The Spatial Plan offers the spatial context for the implementation of the Strategic Care Plan. In that Strategic Care Plan, approved by the Flemish government in 2009, the UZ Brussel describes its vision and development strategy on care, now and in the future. Several actual building projects resulted from the Spatial Plan that shall shape the future UZ Brussel, based on the draft 'Caring architecture'. The entire operation of building projects shall be divided in two large phases: VIPA 1 and VIPA 2.
An application was submitted with the Flemish government in 2011 to subsidise the VIPA 1 building projects.
Via the Spatial plan, the UZ Brussel is working on an even more efficient care infrastructure. Diabetes type 2 is assuming epidemic proportions globally and certainly in Brussels as the most cosmopolitan city in Belgium. That was why the UZ Brussel opened the first integrated diabetes clinic in Belgium in 2011. Diabetes patients however more than ever have a need for customized care with attention to cultural diversity, certainly in Brussels.
Almost all disciplines dealing with diabetes are working within a single new infrastructure.
By combining all disciplines within one organisation and infrastructure, multi-disciplinary 'face to face'-discussion becomes possible, expertise is refined and research is optimised. New technology is constantly emerging, both on a software level and that of medical apparatus. The UZ Brussel also continues to consider that technology must offer tangible improvement for the patient, healthcare and the care provider. This was the first in medical imaging to combine an adequate image quality with an extremely low radiation dosage. Until a few years ago, CT-scan imaging was accompanied by the highest radiation dosage in radiology.
The radiology section at the UZ Brussel has carried out research with the manufacturer of the ultra-low dose CT-scanner on low dose CT-scans. The UZ Brussel developed an electronic aid to discover and react to changes in patients' vital functions faster. Thanks to this software, serious complications can be predicted and treatment can be started on time to avoid this. The use of this software can reduce the number of deaths and complications by at least 10 %.
Changes in vital functions are often not noticed or noticed too late, the severity is underestimated or knowledge and experience is lacking to be able to respond sufficiently. When the values of the vital functions are entered by the doctor or nurse in the electronic patient file, the programme automatically calculates a score from 1 to 6. After the early warning score was extensively tested on two nursing wards in 2010, it was taken in use with adults in 2011 throughout the entire hospital. Quality management and patient safety are recurring threads throughout the UZ Brussel' policy. Both the patient and the care provider must after all be able to spend their time in the hospital in the most secure circumstances with as little room for error as possible.


Not only medical and nursing care must take place safely, mistakes could sneak in during the preparation of meals, the administration of medication, lab-analyses, maintenance and use of materials, finalizing the administration, etc., that could lead to (possible) damage. The VIKA (QICR - Questions-Incidents-Complaints-Recommendations) electronic reporting instrument is therefore accessible to everyone and is subdivided in various categories of incidents. In 2011, the existing classification was extended by another 3 types, medication safety, unsafe situations and other incident types (general report form).
Every incident is checked by one of the indicated administrators and where necessary, actions are taken to prevent repetition. In 2011, this was the case for processing aggression reports, in which mostly personnel are involved. The members of the VIKA-committee are in charge of the system and carry out campaigns to stimulate its use. During the '14-day patient-safety drive' in November 2011, an information program was organised for the fifth time. During such a round, policy keepers are inspecting the nursing wards to see whether the existing safety procedures (e.g.
Based on a checklist which is available electronically, the anaesthetist, the nurse and the surgeon must explicitly check a number of details before every surgical procedure, like the identity of the patient, the presence of the material and the correct operation. The full process, from order to application is followed electronically within the Clinical Workstation, therefore the risk of mistakes became smaller and possible errors in this procedure are easier to be found.
Raising awareness on patient safety of both patients and care givers also falls under the denominator 'quality control and patient safety. During the 'Patient safety Week in November 2011, all employees were informed about the importance of patient safety via information stands at the staff canteen, showing a film collage with testimonies by 30 employees on patient safety, followed by a debate and 'After-work drink' under the slogan of patient safety. Patients were also informed about the importance of keeping an eye on their own safety, amongst others by listing clear tips in the revised admission brochure. The hospital strives to give answers to the informed and critical oriented patients of today via the website, general folders and brochures, and ward and pathology related folders. Information campaigns were also organised in 2011, like during the 'Dietician's Week' (March) in the policlinic in Dilbeek on 'healthy food and sensible drinking', free screening of students on the risk of cardio-vascular and kidney diseases on 'World kidney day' (10 March), on 'European Heart Failure Awareness Day' (7 May) info sessions, info stands, advice on movement, quitting smoking and stress and free blood pressure, weight and middle measurement evaluation, during the 'Heart Week' (September) information on symptoms, treatment options and how to live after a heart attack and during the 'Premature Birth Week' (November) information on problems with premature births. The Care paths or clinical paths are just another product the UZ Brussel also implemented to position the patient in the centre of care and to improve the care even further. A care path is a description of the full path a patient with a specific disorder has to follow in the hospital, in other words from the diagnosis through to the treatment, both inside and outside the hospital. A clinical path can ensure that the hospital rely even more efficiently on the family physician and after admission, the family physician can immediately pick up on the hospital message.
The IT services at the UZ Brussel have developed software that makes it possible to integrate care paths in the Clinical Workstation.
The care paths for heart failure and rectum carcinoma (rectum cancer) were developed in 2011. Different quality control aspects of the UZ Brussel were awarded external accreditation in 2011.
The Centre for Reproductive Care was accredited by the Federal Drugs and Health Products Agency (FAGG) as human tissue bank. The hematopoietic stem cell bank was accredited by the Joint Accreditation Committee-ISCT Europe (JACIE) controlling the standards for stem cell transplants. The Molecular Pathology section and DNA-laboratory of the Centre for Medical Genetics acquired a BELAC-accreditation (BELgian ACcreditation system).
The UZ Brussel has for many years co-operated with many other hospitals and healthcare institutions.
From within the PGD-network (Pre-implantation Genetic Diagnostics), forces were joined with the UZ Leuven and Heilige Hart Hospital in Leuven, the Louvain-La-Neuve University and the AZ Jan Palfijn in Ghent. As planned in the Radiotherapy association agreement with the ASZ Aalst, the radiotherapy section UZ Brussel - campus Aalst was opened in the ASZ Aalst at the beginning of 2011. The satellite clinic of the UZ Brussel Centre for Reproductive Care in the Royal Hayat Hospital in Kuwait was also operating at full swing in 2011. For the UZ Brussel as a university hospital - which, apart from Care and Research, also counts Education as one of its three core tasks - this is extremely important. The ties with the Free University Brussels, of which UZ Brussel forms part, and the alliance partner Erasmus College Brussels, were strengthened further in 2011 with the implementation of a working group within nursing. Nursing on campus is a steering group merging the nursing group of the UZ Brussel, the Erasmus College Brussels and the Brussels Free University in a consultation platform. The steering group ensures that the UZ Brussel, the Erasmus College Brussels and the Free University Brussels achieve a better public image together. Prospective students can for instance be informed of education at the University College and the University, and prospective nursing staff can be recruited for a career in the hospital. From this intensive co-operation also followed the development of a new working group on scientific nursing trials and the organisation of monthly seminars. The purpose is to jointly inspire students and staff to carry out research in a nursing environment. It is therefore important to regularly listen to what they have to say about the healthcare being offered. The UZ Brussel has done this for some years already, amongst others by participating as one of the 10 Flemish hospitals in a 6-monthly questionnaire on patient satisfaction. Numerous indicators were questioned, from an opinion on the hospital in general to sub-sections like accessibility, the room, meals, quietness on the ward and the aftercare. The UZ Brussel shall in future participate in the Quality Indicator project, an initiative in which almost all Flemish hospitals participate and of which the quality indicators were established in co-operation with the Flemish patient platform. The Patient Rights Act of October 2012 states that each hospital has to have an independent ombudsman service that a patient can approach in case of a complaint. Although this does not have anything to do with patient satisfaction surveys, it is obvious that complaints can also be an indication of possible points of improvement in the hospital's healthcare. The UZ Brussel ombudsman service is registered with the Flemish Association Ombudsman function of All Care Providers (VVOVAZ). In 2011, it became clear that the UZ Brussel patients found their way to the ombudsman services even easier. The hospital also took steps by publishing information on the ombudsman services on the hospital website, the distribution of folders on patient rights at the info counter and clear signage to the ombudsman services.
38 % of the complaints were related to the quality of healthcare and medical treatments in particular. The registration system indicated that the average number of complaints related to quality of care during hospitalization, amounted to 57 %. In 2011, patients still too often experienced that they received too little information on the cost of an admission and that their privacy wasn't always respected in the hospital.
The departmental organisation, lectures and the personnel aspects in particular, were a new adventure.
The Kariba-district where I worked is half the size of Belgium and therefore it wasn't all that simple to reach the people. What I eventually found very difficult was that as a doctor you often do not have the necessary medicines to help the people. Well, the biggest advantage of the hospital is the openness with which people interact with each other, and that is typical of the VUB.
You also see this in the close co-operation on scientific level between the orthopaedics, radiology and anatomy sections. Due to the good working relationship, projects can be started that are often difficult to launch elsewhere.
As a university hospital, apart from healthcare and education, research is one of the three core tasks. Research is stimulated via the University Medical Centre Research Council (UMCOR), a merger of the scientific research groups of the Brussels Free University and the UZ Brussel. Between 2005 and 2010, the number of published scientific articles increased from 208 to 423.
Samuel Bral wrote a doctoral thesis on 'Radiotherapy in non-small cell lung cancer: is the only way up?' and Evy Vandemeulebroucke on 'Preservation of Functional Beta Cell Mass, Assessed by Hyperglycaemic Clamp, in Human Type 1 Diabetes'.
The UZ Brussel successfully conducted a pilot study to treat intestinal cancer in patients who are no longer eligible for an operation or chemotherapy with high precision radiotherapy.
As much as half of the patients showed a total or partial reduction of the disease and more than 85 % were still alive a year after treatment. Apart from lung cancer, intestinal cancer is the most important cause of death due to cancer. The UZ Brussel was the first hospital in Belgium in 2011 to start using xenon-gas as aesthetic in operations. For patients with a markedly impaired left and right ventricular function, this is even worse. The gas after all has a specific supportive effect on the blood pressure, and does not have any negative influence on the contraction of the cardiac muscle. The book 'The Life and Times of Guillaume Dupuytren, 1777-1835', on the talented French hand surgeon, was released in 2010.
She was awarded this prize for her explanation on the follow-up and outcome of children born prematurely.
The purpose of the learning clinic is to maximise the chances of children with learning impairments to succeed and develop. The team was awarded the BNP Paribas Fortis Foundation Award Brussels Region for the mission in 2011.
The KWS of the UZ Brussel was awarded the 'Stage 6'-label by the Healthcare Information & Management Systems Society (HIMSS).
7 levels (from 'stage 0' through 'stage 7') correspond with the degree of automation within hospitals.
The UZ Brussel achieved in 2011 for the 3rd year in a row the label 'Top Employer', allocated by the Corporate Research Foundation. This achievement is based on a prior objective survey by a panel of assessors under leadership of the Hay Group. To be able to perform these core tasks, the hospital works closely with the Faculty of Medicine and Pharmacy of the Brussels Free University (VUB) at the green campus Jette. The healthcare department of the Erasmus University College Brussels (EhB), also forming part of the campus Jette, maintains strong contacts with the UZ Brussel, also in the context of the existing higher education accord between the VUB and EhB within the University Association Brussels (UAB).


The UZ Brussel offers all (para)medic, pharmaceutical and biomedical secondary education at this campus, both general clinical and specialist (doctor-specialist) education, apart from permanent education for specialists, GP's and other paramedic personnel.
Offering normal specialist healthcare in all disciplines, a mix between scientific and clinical activities and the development of targeted activities in the narrow co-operation within the University Association Brussels offer the necessary guarantees for the quality of this education.
The competency and expertise profile of the instructors and the institution is furthermore guaranteed by their academic embedding. All (para)medic studies at the campus is aimed more and more at the presentation of context related knowledge units, skills and attitudes, embedded in professional performance.
Working 'the way it is' is taught systematically using both preparatory practical training, taken care of by the UZ Brussel, as practical training in the Skills lab.
The Skills lab is a unique collection of technological gadgets and clinical knowledge, supported by the UZ Brussel. The 'Clinical Skills and Simulation Centre' is coordinated and controlled by the department Critical Care, more specifically by the titulars and the instructors of the Medical Skills training components. The pinnacle of this realistic education can obviously be found in the masters in Medicine internships. These are the most extensive masters in Medicine internships of all medical education in Flanders. It is during these internships that the translation of theory into practice must occur and the skills and approach that a doctor will use his entire life will be acquired.
The UZ Brussel offers an essential support in this by presenting internships in all its departments. The recruitment challenge has after all become much less acute in 2011, because many students continue on with a job in the UZ Brussel. All these internships and practical exercises can obviously not take place without intensive supervision from the departments presenting them. This supervision is organised as effectively as possible, with a large emphasis on student directivity.
On the level of training of the teachers, the FUB gives its members who are involved in teaching activities, the opportunity to follow various trainings and educational programmes at the Campus of Jette, organised by the Quality Control and Education Innovation cell. Newly appointed lecturers and assistants are expected to participate in a course in professional education.
In this course emerging instructors are confronted with a critical analysis of their own educational skills. Both forms of quality control were greatly appreciated by the visitation doctors training in Flanders. Besides the courses of the Masters in Medicine in the UZ Brussel, we also provide the education for the medical specialists in training. The Master after Master (ManaMa) programme in specialist medicine was established in the academic year 2009-2010, within the Flemish University and in close co-operation with the professional field.
The CanMeds role models (role models based on the professional skills of the doctor-specialist) are used as a reference guide for this education. Within the Flemish Inter-University Council the university internship masters of the UZ Brussel contribute to determining the final competences in the various specialisations and the operationalisation of the educational programme. The UZ Brussel offers a range of specialisations sure to cover all disciplines and sub-disciplines of Specialist Medicine. The university internship supervisors are ZAP members (academics) of the Free University of Brussels (full-time or part-time) and are nationally and internationally accredited specialists in their fields.
They were, apart from their educational qualities, selected based on their research file and their professional specialism in the area of patient care.
The UZ Brussel and the medical studies of the Faculty of Medicine and Pharmacy of the FUB complement one another nicely.
Of the 15 patients that we treated in the first study, five people have been better for more than a year now. This research trial follows 10 years of development of dendritic cell therapy and the future offers us an attractive perspective. Once the RIZIV has undersigned the agreement with the UZ Brussel we will receive financial intervention for our patients.
If the results of this body cell therapy are confirmed we can make the difference between life and death for many people. This also means that the trial itself cannot be moved from the FUB, where I also followed my education.
I specifically ended up in oncology due to a prospective mandate of the Fund for Scientific Research in Flanders. The last two years of the training to become physician I did not really know which way I wanted to go. Until I saw the proposal to combine the studies for internist with four years of scientific research into the molecular background of cancer thanks to a scholarship from "Kom op tegen kanker" via the FWO Flanders. This was extended for the last ten years in the clinical research into cell-therapy for melanoma. The Human Resources department is available to all hospital employees, this goes without saying. The HR department should therefore also have the right people in the right place for the various service aspects. Apart from the HR service centre which concentrates on the individual employee, the concept of HR business partners was further developed in 2011 for this goal. Their task is specifically directed at assisting the Heads of Department with their people-task: recruiting new employees, coaching their teams, solving organisational issues.
In the Centre for Reproductive Medicine for example, the business partners guided the acquisition of employees in Abu Dabi in 2011, in the pharmacy they gave advice on the new internal organisational structure.
Reversed, the department heads can also turn to their business partners with questions and problems. The HR business partners approach symbolises where the department would like to go in future. By thoroughly analysing every department, every issue, the problem of bottleneck jobs can for instance be addressed more effectively. In order to give you an idea: The Flemish Department for Recruitment and Vocational Training recorded 8,921 open vacancies for nurses at the end of 2011. The UZ Brussel has been very successful here, the through-flow from internship to employment has been very successful.
But in order to convince people to apply for a job at the UZ Brussel, one has to reach them first. Communication is an important way of introducing the hospital and employees to the outside world.
The magazines published by the communication department (the three monthly magazine Muze for general practitioners and the monthly magazine for employees) are another example of the transparency that the UZ Brussel is striving for. This is also why an evaluation procedure was introduced for the medical Heads of Department.
After these five years, a round-up is made with, amongst others, the input of colleagues about their supervisory capabilities and actualisations and such.
The purpose of this is to assist people in developing their task as supervisor further and to guide them where necessary. There is a central reception, supplemented with multiple discrete work spaces for in depth and more discrete discussions. Another example of the 'open door' with Human Resources, is the introduction of 'Top desk', an electronic question and reply bank for quick and correct service.
With this system, individual questions by personnel can be answered better and faster, 24 hours a day.
Doctors in training received a legal framework which better describes their performances, working and on-call hours in 2011. A protocol was drafted on this in co-operation with the doctors and will be followed up further. A reformation of the additional pension plan was drafted, commencing on the first of January 2012, in discussion with the social partners. Employees receive many training opportunities, both to optimise their performance as well as for personal development.
The VTO policy (Formation, Training and Education) received a boost in 2011 with amongst other an extended and diverse range of educational opportunities. An active training policy is encouraged even more intensely throughout the entire hospital. An example: Quality at the counter, French, English and Team coaching trainings were organised at the patient administration department. 2011 introduced the further exchange of the on-call service with the heads of department of various departments.
I am sometimes also responsible for the dispatch of transport and regularly spend time in the mortuary. Like many other young men, I would have like to become a professional soccer player, but unfortunately I had too many problems with my knee.
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It’s a great example of the positive impact pharmacists can make when positioned properly in the healthcare system. From my own experiences in a large HMO, I finding about 50% errors, and thanks to the pharmacist that caught the last one.
Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care. Wylock received the 'Prize for the history of medicine, period 2005-2010' from the Royal Academy for Medicine of Belgium for his book in 2011.
Wendy Werckx of the Paediatric Neurology services received the prize for best presentation of the Belgian Society of Paediatric Neurology this year. More importantly, without adequate dissemination it can be difficult for other institutions to benefit from the practices reported here and ultimately to generate improvements for patients.



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