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in its writing, inclusion of information, improper prescription, and even incorrect prescription. The impact of these errors can lead to several factors that can be detrimental, ranging from the inaccuracy of drugs given to certain individuals, errors in measuring the dose given, or incompatibility of drugs with certain patients so that it can result in disability or death. This study aims to determine the completeness of outpatient prescriptions according to prescribing SOP compliance served in the internal disease polyclinic of MM Indramayu Hospital. This study used a descriptive method which was carried out retrospectively using activity data for the period January - December 2020. Sampling was carried out using the Slovin formula and obtained 380 recipes. Based on the data collection and analysis carried out in this evaluation, it can be seen that the administrative completeness of prescriptions that meet the requirements are (74.73%), while the administrative completeness of prescriptions that do not meet the requirements are (25.26%). Administrative documents that meet the criteria are Signature, Incryptio, Invocation, Patient Name and Age (100%), while other administrations are Praescriptio/Ordonatio (28.68%), Subscriptio (45.26%), and Address (75.78%). From this evaluation, it can be concluded that many outpatient prescriptions meet the completeness aspect of the prescription SOP at MM Indramayu Hospital. However, improvements in prescribing need to be done so that there are no prescriptions that do not meet the requirements. This can be done by reviewing doctors to be more thorough and clear in prescription writing, communication between pharmacists and doctors or medical audits of prescription writing

Objective: To evaluate written prescriptions according to a checklist based on WHO guidelines (prescription audit). To compare prescriptions of senior and junior physicians and to provide data and recommendations. Study Design: Cross-sectional, analytic study. Place and Duration of Study: Pak Emirates Military Hospital, and Combined Military Hospital, Rawalpindi Pakistan, from March to Aug 2018. Methodology: A total of 205 prescriptions using convenient sampling technique were analyzed according to a checklist based on WHO guidelines for standard prescription writing. Data was analyzed using SPSS-22. Results: Out of total 205 prescriptions, 83 (40%) prescriptions belong to senior and 122 (60%) to junior physicians. Fifty (25%) prescriptions lacked patient name, 49 (24%) lacked age. Gender was mentioned in only 117 (57%) prescriptions. Date, diagnosis and dosage of drug were written in 170 (83%), 172 (84%) and 177 (86%) respectively while dosage form and route of administration were mentioned in 144 (70%) and 102 (50%) respectively. Generic name was written in only 75 (37%) prescriptions. Name and stamp of the doctor were available on 135 (66%) and 125 (61%) prescriptions respectively. A statistically significant association was observed between senior and junior physicians in terms of error in name of patient and dosage form (p=0.002& 0.005 respectively). Conclusions: Prescriptions were mainly deficient in the generic names of drugs. Route of administration was missing in half of the prescriptions. None of the parameters was totally accurate. Prescriptions from junior physicians had more errors.

BackgroundWestern countries report a significant increase in the proportion of patients who experience out-of-hospital cardiac arrests (OHCAs) and benefit from a public automated external defibrillator (pAED) before the arrival of rescue teams. However, recordings of devices recovered after resuscitation are of variable quality. Analysis of these data may inform decisions of whether to implement an internal defibrillator for survivors, and provide useful information about the performance of pAED algorithms and the actions of bystanders.ObjectiveTo investigate the quality of the information recorded by pAEDs during OHCAs in the Paris area.MethodspAED files used for some of the 8629 OHCAs that occurred in the greater Paris area between 1 January 2017 and 31 April 2019 on the day of the arrest were collected. The presence and accuracy of 23 factors required to interpret the recording was noted, including readability of the ECG, the presence of an impedance curve and the accuracy of the date and time. The recordings were analysed to assess the diagnostic and therapeutic performance of the pAEDs used.ResultsA total of 258 patients with an OHCA received assistance from a pAED, and 182 recordings were recovered. The pAEDs were made by 12 different manufacturers. Data extraction required eight different transmission modes and 16 software programmes; recordings were of highly heterogeneous quality. Two per cent of the recordings were of such poor quality that they were not interpretable. Among the 98% remaining, only 43% included a thoracic impedance curve, 34% the intensity of the shocks delivered and 8% the patient name. The date and time were accurate in 68% and 48% of recordings, respectively. The pAEDs had 87.6% (95% CI 83.7% to 91.0%) sensitivity and 99.5% (99.5% to 99.5%) specificity for defibrillating shockable rhythms (positive predictive value 98.2% (96.4% to 99.0%), negative predictive value 96.4% (95.3% to 96.8%)). The absence of important variables prevented the analysis of approximately half of the inappropriate decisions made by pAEDs.ConclusionCollection of pAED recordings is a major challenge. Their analysis is compromised by heterogeneity and poor quality (incomplete maintenance records, patient details and logs). AED recordings are currently the most relevant resource to track pAED performance and bystander practices. The quality of these recordings needs to improve.

Remote patient monitoring (RPM) devices are a novel method for physicians to monitor their patients after discharge and long after they have gone home. Usually RPM devices are bulky, relatively expensive, restricted in the physiological parameters they measure and are hard to operate.MEDLINK is a low cost (~$C1500), verbally interactive, programmable and portable RPM device that possesses the ability to verbally interact with a physician to obtain his or her information as well as the patient’s key statistics, and then to obtain the physician’s selection of physiological parameters he or she wishes to remotely monitor from that particular patient. When the patient switches on the unit, MEDLINK also verbally interacts with the patient to measure and acquire the physician’s selected physiological parameter and sends this information to the physician’s phone, via text messages and emails. Security and privacy of patient’s medical data can be preserved by using the patient’s ID instead of patient name.Physiological parameters that can be acquired by MEDLINK include: ECG, blood pressure, heart rate, blood glucose, pulse rate, blood oxygen saturation, electromyography, body temperature, spirometer, respiratory rate and much more. Future work involves the integration of more biomedical sensors to the existing MEDLINK product to expand its range of measurable physiological parameters to its maximum, and to conduct a short clinical trial on the product prior to commercialisation.

Marginal adaptation is an important feature of implant-supported crowns, ensuring long-term survival and the success of the prosthetic restoration. The long-term success of a fixed prosthesis such as an implant is highly associated with its marginal adaptation. Improper marginal adaptation increases the risk of plaque accumulation, which leads to decay and periodontal diseases and eventually results in the failure of the fixed dental restoration. The aim of this study is to evaluate the marginal fit of different types of implant-supported crowns following the cementation procedure. It is a retrospective study conducted by reviewing 86,000 patient case records of the Saveetha Dental College and Hospital, Chennai, India. A total of 196 consecutive case records of patients for a period of June 2019 to March 2020, with signed informed consent, were retrieved and analyzed. Information such as patient name, patient identification number (PID), age, gender, marginal adaptation, and type of materials was retrieved from patient case records. Data were entered in Excel and analyzed using SPSS software version 23.0. Descriptive analysis was done for the assessment of age, gender, type of materials, and marginal adaptation. A Chi-square test was used to evaluate the association between marginal adaptation and type of materials. The significant level was set at less than or equal to 0.05 (p ≤ 0.05). In this study, we observed that all-metal, metal-ceramic, hand-layered, and monolithic crowns mainly have smooth margins adaptation (52.55%) following cementation. The placement of implant-supported crowns is mostly done in individuals within the 21-30 years age group (29.08%). A higher prevalence of implant-supported crowns is seen in males (61.73%) compared to females (38.27%). Within the limits of the study, placement of implant-supported crowns is done mainly in individuals within the 21-30 years age group, with higher predilection in males compared to females. Metal-ceramic crowns are commonly placed, followed by hand-layered crowns, monolithic crowns, and all-metal crowns. Most of the implant-supported crowns exhibit satisfactory marginal adaptation with smooth margins. However, there is no significant association between the types of material and marginal adaptation.

Incomplete prescribing can be one of the causes of medication errors in patients. This incident can be avoided by screening prescriptions by pharmacists at pharmacies which include administrative and pharmaceutical studies. The purpose of this study was to determine the administrative and pharmaceutical prescription completeness in June-December 2018 at CS Farma Pharmacy. The research method was descriptive nonexperimental with retrospective data collection. Samples were collected by simple random sampling technique and obtained 385 pieces of recipes that have met the inclusion criteria. The result shows that the completeness of administrative prescriptions consisted of: patient name 99,22%, patient age 88,05%, sex 9,09%, body weight 0%, doctor's name 3,64%, doctor's SIP 0% , prescription date 97,92%, doctor's address 100%, doctor's telephone number 0,26% and doctor's initial 6,23%. Pharmaceutical aspects consisted of: dosage form 69,61%, dosage strength 57,66%, drug stability 100% and incompatibility 100%. It can be concluded that the prescription in CS Farma Pharmacy on June-December 2018 was not complete administratively and pharmaceutically yet, based on Permenkes No.73 In 2016.

Expedited partner therapy (EPT) is an effective strategy for partner management of sexually transmitted infections. Some states, including Wisconsin, allow EPT prescriptions to be filled without a patient name. This study determined the refusal rates of nameless EPT prescriptions in Milwaukee pharmacies.In this cross-sectional study, 3 trained research assistants of different age, sex, and race posed as "patients" and visited 50 pharmacy locations from one pharmacy chain in Milwaukee County, WI, to fill nameless EPT prescriptions. A χ test was used to compare demographics of patients, pharmacists, and pharmacies. Multiple logistic regression was used to identify factors associated with prescription refusal.Twenty-nine (58%) of 50 nameless EPT prescriptions were refused. Univariate analysis showed that prescriptions were more likely to be refused if the pharmacy was in the suburbs (77%) compared with Milwaukee city (43%; P = 0.01), if the pharmacist was older than the patient (82%) compared with being younger (46%) or within the same age group (33%; P = 0.01 for both), and if the patient was white (78%) compared with nonwhite (47%; P = 0.03). Multivariable regression revealed significantly higher refusals for pharmacies located in the suburbs compared with the city (odds ratio, 5.3; 95% confidence interval, 1.4-20.3; P = 0.03) and in patients who were white compared with nonwhite (odds ratio: 4.8; 95% confidence interval, 1.2-19.8; P = 0.01).More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.

SETTING Regional tuberculosis (TB) centres of the Yangon and Mandalay Regions of Myanmar, which account for 65% of all notified rifampicin-resistant tuberculosis (RR-TB) cases countrywide. OBJECTIVE To determine 1) initial loss to follow-up (LTFU), 2) treatment delay, and 3) factors associated with initial LTFU and treatment delay among RR-TB patients residing in the Yangon and Mandalay regions diagnosed using Xpert® during January-August 2016. DESIGN This was a retrospective cohort study. Each diagnosed patient was tracked in the drug-resistant TB treatment registers of the Yangon and Mandalay regional treatment centres for January-December 2016 using patient name, age, sex, township and date of diagnosis. If the diagnosed patient was not found in the treatment register by 31 December 2016, he/she was considered 'initial LTFU'. RESULTS Of the 1037 RR-TB patients diagnosed, 310 (30%) experienced initial LTFU, which was significantly higher among patients aged 55 years and among those diagnosed in the Mandalay Region. A treatment delay of >1 month was observed in 440 (70%) patients (median delay 41 days). Delay was uniformly high across patient subgroups, and was not associated with any factor. CONCLUSION Initial LTFU and treatment delays among RR-TB patients were high. Future studies using qualitative research methods are needed to ascertain the reasons for this observation.

Background Bedside medication lockers are widely used in hospitals for storing inpatient and discharge medications; however, there is a risk that inpatient medicines may be inadvertently supplied at discharge. Aim To quantify the extent of inappropriate medications found in bedside medication lockers, in order to develop future strategies to reduce the risk of patients being discharged with inappropriate medications. Methods A pharmacy assistant checked the bedside medication lockers of admitted patients against the current inpatient medication charts twice a week for 2 months in a surgical ward of an Australian tertiary hospital. The pharmacy assistant identified, documented and removed the ceased, non-prescribed and other patient's medications. The hospital reporting system was queried for reports of non-prescribed medicines being sent home at discharge at the end of the study period. Results Over 2 months, 533 of 557 (96%) admitted patients had their bedside medication lockers checked on the designated days. Medications were removed from 101 (19%) of the 533 bedside medication lockers checked. Of the 187 medications removed, 73 (39%) were ceased, 104 (56%) were not current and 10 (5%) were labelled with a different patient name. Review of the hospital reporting system did not identify any reports of surgical patients discharged with inappropriate or unlabelled medicines. Conclusion Checking bedside medication lockers by a pharmacy assistant has highlighted a number of inappropriate medications that could potentially be discharged with the patient if appropriate medication reconciliation does not occur. This area of medication management requires further investigation to determine if this process reduces the risk of medication misadventure on discharge.

Background: Need for a permanent control person and alarm fatigue are limitations of telemetry surveillance systems ending at the central surveillance monitor. This study evaluated an escalation system expanding the alarm sequence by smartphones. Methods: Telemetry system with 26 monitoring units and WLAN based alarm escalation system to three smartphones (Care Event, Philips) was evaluated during 128 days regarding major arrhythmia alarm (MAA) frequency, escalation of alarms within the system and response times. ECG triggering the MAA, patient name and position are shown on the smartphone display. MAA are forwarded initially to smartphone one. Forwarding of MAA to two further smartphones is actively triggered or occurs automatically after 20 sec without response by smartphone one. Results: During the analysis period 11576 MAA were forwarded, ranging from 15 to 238 alarms/day. The number of MAA was minimal at 11 pm and maximal at 8 am (ratio 1:1.8). In 69% only smartphone 1 was involved, in 31% occurred an escalation to smartphone 2 and in 13% to smartphone 3. The median MAA response time at the smartphone was 8 sec at daytime and 9 sec at nighttime. 14 min of running time could be saved on average every day by direct visit of the patient triggering an alarm and omission of the central monitoring system. Conclusions: A smartphone based alarm escalation system redundancies the permanent presence of nursing staff at the central surveillance system. The multilevel surveillance system with smartphone based escalation allows low alarm response times and warrants excellent surveillance quality

BACKGROUNDMislabeled samples are a serious problem in most clinical laboratories. Published error rates range from 0.39/1000 to as high as 1.12%. Standardization of bar codes and label formats has not yet achieved the needed improvement. The mislabel rate in our laboratory, although low compared with published rates, prompted us to seek a solution to achieve zero errors.METHODSTo reduce or eliminate our mislabeled samples, we invented an automated device using 4 cameras to photograph the outside of a sample tube. The system uses optical character recognition (OCR) to look for discrepancies between the patient name in our laboratory information system (LIS) vs the patient name on the customer label. All discrepancies detected by the system's software then require human inspection. The system was installed on our automated track and validated with production samples.RESULTSWe obtained 1 009 830 images during the validation period, and every image was reviewed. OCR passed approximately 75% of the samples, and no mislabeled samples were passed. The 25% failed by the system included 121 samples actually mislabeled by patient name and 148 samples with spelling discrepancies between the patient name on the customer label and the patient name in our LIS. Only 71 of the 121 mislabeled samples detected by OCR were found through our normal quality assurance process.CONCLUSIONSWe have invented an automated camera system that uses OCR technology to identify potential mislabeled samples. We have validated this system using samples transported on our automated track. Full implementation of this technology offers the possibility of zero mislabeled samples in the preanalytic stage.

Introduction: Hospital admission within 72 hours of emergency discharge is a widely accepted measure of emergency department quality of care. Patients returning for unplanned admission may reveal opportunities for improved emergency or followup care. Calgary emergency physicians, however, are rarely notified of these readmissions. Aggregate site measures provide a high level view of readmissions for managers, but dont allow for timely, individual reflection on practice and learning opportunities. These aggregations may also not correctly account for variation in planned readmissions and other workflow nuances. There was a process in place at one facility to compile and communicate readmission details to each physician, but it was manual, provided limited visit detail, and was done weeks or months following discharge. Methods: A new, realtime 72 hour readmission notification recently implemented within the Calgary Zone provides direct and automated email alerts to all emergency physicians and residents involved in the care of a patient that has been readmitted. This alert is sent within hours of a readmission occurring and contains meaningful visit detail (discharge diagnosis, readmit diagnosis, patient name, etc) to help support practice reflection. An average of 15 alerts per day are generated and have been sent since implementation in April, 2017. Although an old technology, the use of email is a central component of the solution because it allows physicians to receive notifications at home and outside the hospital network where they routinely perform administrative tasks. A secondary notification is sent to personal email accounts (Gmail, Hotmail, etc) to indicate an unplanned admission has occurred, but without visit detail or identifiable information. It also allowed implementation with no new hardware or software cost. Results: A simple thumbs up/down rating system is used to adjust the sensitivity of the alert over time. More than 66% of those providing feedback have indicated the alert is helpful for practice reflection (i.e., thumbs up). And of those that indicated it was not helpful, comments were often entered indicating satisfaction with the alert generally, or suggestions for improvement. For example, consulted admitting physicians are often responsible for discharge decisions and should be added as recipients of the alert. Conclusion: Many physicians have indicated appreciation in knowing about return patients, and that they will reflect on their care, further review the chart, or contact the admitting physician for further discussion. Most are accepting of some ‘expected’ or ‘false positive’ alerts that aren’t helpful for practice reflection. Further tuning and expansion of the alert to specialist and consult services is needed to ensure all physicians involved in a discharge decision are adequately notified.

In the prescription service flow, pharmacists are required to do prescription screening which includes administrative screening, pharmaceutical suitability and clinical considerations. The administrative and pharmacetic aspects of the prescription were chosen because it was the initial screening when the recipe was served at the pharmacy because it included all the information in the recipe relating to the clarity of the drug writing, the validity of the recipe, and the clarity of the information in the recipe. This research was conducted to find out how the administrative and pharmacetic prescriptions at the Kumbum Pos Pengumben Pharmacy in the period of August to December 2018 fulfilled the prescription completeness according to Minister of Health Regulation No. 73 of 2016. Administrative and pharmacy checks were carried out on 288 prescription sheets by filling in the tables Data collection (Checklist) in accordance with the completeness aspects reviewed. From the results of the study showed the incidence of incomplete prescriptions at the Post-Pengumben K-24 Pharmacy namely 99% body weight, 36% sex, 28% patient age, 1% patient name, 6% doctor name, 28% SIP, as many as 1%, telephone number as much as 15%, initial as much as 53%, prescription date as much as 2%, preparation as much as 25%, dosage strength 24%, drug stability 1%, and 0% compatibility. The complete prescription at the K-24 Pharmacy Station Post has not fulfilled the administrative and pharmaceutical requirements in accordance with Permenkes No. 73 of 2016.

Our software has two modules include in it extraction of data & EHR system with cloud . Now a days there is a busy schedules of doctors so they have no time to read the huge amount of articles ,they discussed the disease related problems either in conference or in the seminar only . So we provide a great extraction approach for this problem to give huge information of articles to the system, the machine learning process is done on the article. It only give the information to the doctors which is they want & related and useful to their work .The second approach includes in our system is that we proposed the EHR(Electronic Health Record) system. Which includes the details information of the patient ex: patient name ,id, address ,photo etc . This data also available on cloud. This information is easily accessible and it requires the less time to be searched the data about disease & treatment. Using the EHR system we can access the medical history of the patient from any location . It reduces the time require for the lab tests , previous treatments, allergies of patient.

Objective To understand the factors that influence success in scrubbing personal names from narrative text. Materials and methods We developed a scrubber, the NLM Name Scrubber (NLM-NS), to redact personal names from narrative clinical reports, hand tagged words in a set of gold standard narrative reports as personal names or not, and measured the scrubbing success of NLM-NS and that of four other scrubbing/name recognition tools (MIST, MITdeid, LingPipe, and ANNIE/GATE) against the gold standard reports. We ran three comparisons which used increasingly larger name lists. Results The test reports contained more than 1 million words, of which 2388 were patient and 20 160 were provider name tokens. NLM-NS failed to scrub only 2 of the 2388 instances of patient name tokens. Its sensitivity was 0.999 on both patient and provider name tokens and missed fewer instances of patient name tokens in all comparisons with other scrubbers. MIST produced the best all token specificity and F-measure for name instances in our most relevant study (study 2), with values of 0.997 and 0.938, respectively. In that same comparison, NLM-NS was second best, with values of 0.986 and 0.748, respectively, and MITdeid was a close third, with values of 0.985 and 0.796 respectively. With the addition of the Clinical Center name list to their native name lists, Ling Pipe, MITdeid, MIST, and ANNIE/GATE all improved substantially. MITdeid and Ling Pipe gained the most—reaching patient name sensitivity of 0.995 (F-measure=0.705) and 0.989 (F-measure=0.386), respectively. Discussion The privacy risk due to two name tokens missed by NLM-NS was statistically negligible, since neither individual could be distinguished among more than 150 000 people listed in the US Social Security Registry. Conclusions The nature and size of name lists have substantial influences on scrubbing success. The use of very large name lists with frequency statistics accounts for much of NLM-NS scrubbing success.

Background: In recent years, there has been a documented increase in the number of professional baseball players on the disabled list and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports. Purpose: To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchers and subsequent time on the disabled list (DL). Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwent preseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasons before the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded to patient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographic data, total career number of innings pitched, and any subsequent DL reports for each subject. Results: The mean age at the time of MRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9 had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP) tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number of innings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was 1014 compared with a mean of 729 innings pitched in pitchers without an RCT ( P < .01). In addition, the number of career innings pitched was moderately correlated with presence of RCT ( r = 0.46) and presence of superior and anterior/posterior labral tears ( r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL. Conclusion: The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL. However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those who did not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions. This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequent strain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear to be more frequent than previously thought.

Elimination of medical errors is important for pathologists. Errors occurring in surgical pathology involve specimen defects, specimen labeling, processing, diagnosis, and reporting defects. Errors occur during prelaboratory, laboratory, and postlaboratory phases. We reviewed our experience with mislabeled specimens in the laboratory for an 18-month period. The percentage of error was calculated on a per case, block, and slide basis. Errors were characterized by site and as incorrect patient or site. The study involved 75 labeling errors (0.25% of cases) that were detected. Of the 75 errors, 55 (73%) involved patient name, and 18 (24%) involved site. The majority of mislabelings (52 [69%]) occurred in the gross room. Although infrequent, labeling errors involved misidentification of patient or specimen source. Of the errors, 73% (55/75) of errors resulted in slides assigned to an incorrect patient. Most errors occurred in the gross room. Newer technologies such as bar coding and radio frequency chip methods may reduce the frequency of specimen labeling errors.

The collection, transport, and processing of clinical specimens are preanalytical steps that are key to organism recovery. Quality specimens must be collected in order to provide the most clinically relevant microbiology results for our patients ( 1 , 2 ). To ensure that specimens are collected in an appropriate manner, easy-to-understand instructions for proper specimen collection and transport conditions in the form of a specimen collection manual or instructional how-to sheet should be available either electronically or from printed material and updated regularly in order to ensure that practices are current. The instructional information should be made available to your clinicians, clinical laboratory scientists, nursing staff, patients, or other clients. Specimens are to be labeled with the patient name and medical records number. The last preanalytical consideration before processing the specimen is to ensure that the specimen is processed in accordance with the test ordered and the organism suspected. The tables in this section are meant to be used as a guide for these important preanalytical steps.

Background: The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes.Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency.Methods: LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage.Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices.Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.

1. Paul Rose, MD, JD (info{at}thehairlosscure.com) 1. Coral Gables, Florida, USA Patient Name: \_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\\_\_ Date: \\_\_\_|\\_\_\_|\\_\_\_|\\_\_\_|\_\_ PROPECIA® is for use by MEN ONLY and should NOT be used by women

Objective. There is no data on the use of hospital-wide online edical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied.Methods. In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patient's record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of howmuch data was copied, the number of characters was also recorded.Results. Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfullyretrieved data from the patient's record. Data wascopied for 170 patients — 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied — an average of 1,543 characters per instance of copying.Conclusion. We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR database, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.

Purpose: To identify and quantify possible errors in handwritten outpatient prescriptions in relation to adherence to standard guidelines on the layout and content of prescriptions. Method: A sample of 200 handwritten outpatient prescriptions were collected from two pharmacies located in a sub-urban (Aluthgama) and an urban (Kandy) area in Sri Lanka. Data were extracted using a pilot-tested questionnaire and the legibility of the prescription was assessed by three independent investigators. The results from the suburban area were compared with those from the urban area. Results: Based on the layout of the prescription, the presence of patient information was unsatisfactory. Patient name and age were present in less than half of the prescriptions. However, prescriber information except registration number was present in more than 75 % of the prescriptions. Date of consultation was present in > 81.5 % of the prescriptions. Non-standard abbreviations were used in 36.5 % of the prescriptions while incomplete units were observed in 51 % of the prescriptions. Nearly half of the prescriptions from both urban and suburban locations were illegible. Occurrence of prescriber details was a significantly different between Aluthgama and Kandy. Conclusion: Prescription errors are common in outpatient settings of Aluthgama and Kandy areas in Sri Lanka. Standardized prescription writing process in relation to layout, use of abbreviations, and units and legibility, is proposed as a potential solution to overcome this problem. Keywords: Medication error, Prescriptions, Standardized prescription writing, Prescriber information, Non-standard abbreviation

Aim To evaluate the usefulness of dose-banding in reducing prescribing errors in a paediatric A & E department Method Dose banding is a process where the dose is determined within defined ranges or bands, based on the age or weight of the child depending on the medication. Dose bands are often used in prescribing cytotoxic agents through an agreement between pharmacists and clinicians. A previous audit conducted in paediatric AE 19% of all errors were dosing errors. The intention of this study was to apply dose-banding to selected medications prescribed in the paediatric AE this was achieved by asking nursing staff to photocopy every prescription issued, morning and night, during this time period. All prescriptions were screened retrospectively for prescribing errors using a streamlined version of a validated data collection tool. Prescriptions written under Patient Group Directions (PGDs) were exempted from dose-banding, but were included in the analysis. Results A total of 590 medication orders (MOs) from 428 prescriptions were screened for different types of prescribing errors over two consecutive weeks. Of these, 450 (76.3%) were doctor MOs and 140 (23.7%) were PGD MOs. A total of 225 (38.1%) MOs contained a prescribing error, giving an overall prescribing error rate of 37.9%. Allergy status was missing in 36 (6.1%), date of birth (DOB) was missing in 98 (16.6%) and the patient name was missing in 88 (14.9%) MOs. Dosing errors occurred in 38 (6.4%) MOs. Of the 450 MOs written by doctors, 194 followed the dose banding schedule and none of these resulted in an incorrect dose; 114 MOs were not written according to the dose bands – and 22 of these had an incorrect dose; 142 MOs were written for drugs that were not included in the dose-banding schedule, and 2 of these had an incorrect dose. Of the 140 MOs from PGDs, 14 had an incorrect dose. Conclusion Overall the dose-error rate for MOs written by doctors was 24 out of 256 (9.4%) for non-dose banded drugs versus 0% for dose-banded drugs. The error rate for PGD MOs was 10%. The results suggest that dose-banding may be a useful strategy to help reduce prescribing errors in paediatrics.

Background The purpose of this study was to compare the completeness and reproducibility of data extracted from a standardized operative report (SOR) with the non–standardized operative report (NSOR). Methods Between July and December 2003, operative data were collected from all laparoscopic cholecystectomy procedures performed at the Peter Lougheed Centre Hospital. A standardized format for dictating laparoscopic cholecystectomy operative reports was introduced on October 1, 2003. Non–standardized operative reports dictated in the first 3 months of the study period were compared with SORs dictated in the final 3 months. Two physicians independently extracted data from each operative report into a surgical database. Results During the study period, 221 cholecystectomy reports were analyzed (119 SOR and 102 NSOR). Completeness of data extraction for identifying variables (eg, patient name, age, and date of procedure) was similar in the 2 types of reports. However, most other operative and perioperative details were more completely reported in the SOR (95% to 100%) when compared to the NSOR (14% to 100% complete). Furthermore, interobserver agreement between 2 independent data extractors was better for the SOR than the NSOR (0.9972 vs 0.9809, P Conclusions Standardized operative reports result in more complete and reliably interpretable operative data compared with NSORs.

In the Cardiology department, many different sources of clinical information are used in the daily routine. Integration of these (digital) sources into an electronic patient record is a logical step. One of the issues regarding the integration of data is the integrity of patient data: there shouldn't be any mis-registration of patient related data such as patient ID, patient name. To achieve integrity of patient data, we have now created a method to automatically transfer patient related data from one system to the other, mostly by using industry standards for communication of these data. With the integrity of these data secured, we can now proceed with the integration of the data into one system

It is important that all images in a picture archiving and communication system (PACS) environment should be stored in the correct location, e.g., in the proper patient's folder. However, if patient information, such as identification number or patient name, has been entered incorrectly, the image may be stored in the wrong place. We are developing an automated patient recognition method for chest radiographs based on a template-matching technique to prevent such filing errors. To further improve the performance of our method, we investigated the usefulness of a new automated patient-recognition method based on a template-matching technique by using edge-enhanced and smoothed images. We found that the relationship between the correlation values obtained with and without the edge-enhancement technique tended to provide different criteria for identifying correct or incorrect patients. When we combined the two methods to distinguish the images by a rule-based method, 67.1% of wrongly identified patients in our database could be identified as wrongly identified, without any false warnings for correctly identified patients. We consider that this automated method for patient recognition based on edge-enhanced images would be useful in preventing "wrong" images from being stored in a PACS environment.

Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. A Rhinos pilot was performed for 6 weeks on 2 clinical services. One hundred sixty-five requests were entered and used in OR assignment decisions by a single attending anesthesiologist. Each request consisted of a rank ordered list of up to 3 ORs. Residents had access to detailed information about these cases including surgeon and patient name, age, procedure type, and admission status. Success rates at matching resident requests were determined by comparing requests with AIMS records. Of the 165 requests, 87 first-choice matches (52.7%), 27 second-choice matches (16.4%), and 8 third-choice matches (4.8%) were made. Forty-three requests were unmatched (26.1%). Thirty-nine first-choice requests overlapped (23.6%). Full implementation followed on 8 clinical services for 8 weeks. Seven hundred fifty-four requests were reviewed by 15 attending anesthesiologists, with 339 first-choice matches (45.0%), 122 second-choice matches (16.2%), 55 third-choice matches (7.3%), and 238 unmatched (31.5%). There were 279 overlapping first-choice requests (37.0%). The overall combined match success rate was 69.4%. Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case-log data in decision support systems for informing resident OR assignments. Additional analysis will be necessary to assess the educational impact of these systems.

Background and Aims Errors are common in paediatric inpatient prescribing. This audit cycle assessed the impact of new strategies aimed at reducing prescribing errors. Methods Drug charts from short-stay admissions in January 2010 were assessed retrospectively. Two gold standards were used; local hospital prescribing guidelines and the British National Formulary for Children (BNFC) 2009. From these results, a number of strategies were implemented to improve practice: prescribing training for new doctors was enhanced; a mandatory prescribing competency assessment was introduced; awareness was raised through local and regional presentations; increasing the availability of BNFC in clinical areas; daily pharmacy endorsements of drug charts and provision of Doctors’ name stamps; and recommendations for a drug chart re-design. We then re-audited using identical methods in July 2010. Results A total of 106 charts were assessed. Changes in documentation were found as follows: Improvements: reason for non-administration (+26%), allergy status (+20%), at least one medication pharmacy-endorsed (+16%), date of birth (+5%), dose in mg/kg where applicable (+5%), frequency for all medications (+2%), ‘micrograms’ written in full (+1%). No change: patient name (100%), no unofficial abbreviations (100%), weight (96%), signature when administered (96%). Worsening: appropriate decimals (–6%), doctor’s name stamp (–6%), start date (–5%), total dose (–2%), administration route (–1%). Conclusions This audit revealed significant improvements in paediatric prescribing following implementation of our recommendations. However, key areas were identified for further improvement. Current work includes continued development of training, a dedicated prescribing area on the ward, regular monitoring of drug charts and continuing re-audit.

Project: In December of DRH fiscal year 2010, the fiscal year to date CLABSI rate in the Critical Care Unit (CCU) was 5.0 per 1,000 device days. At that time, two staff nurses volunteered as unit ‘‘Champions’’ to foster accountability and decrease CLABSIs in the CCU. As members of the hospital multidisciplinary CLABSI prevention team it became evident change had to come at the unit level. Champions began ‘‘CCU per case’’ education, monthly line and infection audits. CLABSIs were referred to by patient name and discussed during daily huddles. Staff meetings emphasized that CLABSIs are preventable. Staff was educated about how CLABSI affected cost, length of stay, morbidity and mortality. Line carts and checklists were updated. New supplies were introduced including a 3.15% chlorhexidine gluconate (CHG) with 70% isopropyl alcohol swab for hub cleaning dressings using a CHG impregnated sponge versus patch. Other soft interventions included bundle education events, a 15 second scrub the hub song and humorous posters. Lastly, we celebrated our success with the staff to reward compliance.

Objective To report on the frequency of pre- and post-analytical errors by participants in the Royal College of Pathologists of Australasia (RCPA) Microbiology Quality Assurance Programe (MQAP). Methods Retrospective review of MQAP data 1987–1991 and 2004–2008. Pre-analytical errors rates were based on participants’ detection rate of clerical errors for patient name and identification number for the given test item. Fictitious errors were defined as the reporting of a labelling error when in fact there was no discrepancy. Post-analytical errors rates were based on clear transcription errors resulting in the test result being incorrectly assigned to another test item. Results When there was one clerical error a median of 9% (range 2–27%) of participants failed to report it. When there were two errors 6% (range 0–29%) failed to report either error. A median of 0.7% (range 0–6%) of participants reported fictitious errors. Of the 83 items where direct transposition errors were possible 54 (65%) had at least one participant who transcribed the results. Pre-analytical errors have not decreased over time. Conclusions Pre- and post-analytical errors are not rare amongst participants in the RCPA MQAP. These non-analytical components of the testing pathway require improvement.

LEARNING OUTCOME: To develop an organized means of providing discharge nutrition education for cardiac catheterization patients. Lack of an effective communication network on the in-patient floor serving cardiac patients led to patients being discharged without adequate nutrition education and heightened tensions between nursing and nutrition staff. The procedure in place at this time, involved nursing or the floor unit secretary paging the floor dietitian just prior to the patient's discharge time. This short notice often did not allow adequate time to instruct the patient properly, if at all, and interfered with other dietitian job responsibilities. Our goal was to develop a more organized means of delivering important nutrition information to cardiac patients while improving the quality of that education. At an interdisciplinary meeting among nursing and nutrition staff a new means of alerting the dietitian to cardiac patients needing discharge education was devised. A sign up sheet with morning and afternoon slots was prepared. Nursing agreed to list daily morning and afternoon discharges and the dietitians agreed to see patients on the list between 9 am and 10 am for morning discharges and between 2 p.m. and 3 p.m. for afternoon discharges. After seeing the patient, the dietitian crosses the patient name off the list so that nursing would know the patient has been instructed. A videotape was also made available on the patient television channel in the event that a dietitian was unavailable to provide instruction, which was often the case on weekends due to reduced staffing. A policy for the new procedure was written and distributed to nursing, the unit secretaries and to the dietitians. The discharge education materials for cardiac education were also revised. From May 1996 through January 1997 nursing listed 168 patients requiring discharge education. Ninety-three percent of these patients were seen by the dietitian for discharge instruction. In addition, a patient and nursing satisfaction survey was circulated. Of the responders, 100% were highly satisfied with the program.

A touchscreen interface was tested as the exclusive means for interacting with a computer-based monitor for the hospital intensive care environment. The use of touch in the medical environment combined with the fact that it was the sole means of user communication presented several human engineering challenges. Human factors testing of the design used 75 hours of mockup review by 38 clinical and administrative staff. In addition, 680 hours of field trial testing in the intensive care environment by 39 hospital staff were performed. The minimum size of visual and touch-sensitive target areas and the proximity of adjacent areas was determined. The touch recognition algorithm was modified to more accurately recognize near-edge targets. The use of a touch-sensitive QWERTY keyboard for patient name and id entry was shown to be acceptable. N-key rollover was deemed not viable with a touch interface in the critical care area. A swivel mount was introduced to compensate for different height and handed end-users.