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At least 109 records · Page 6Linked to original sources
PubMed2005

Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.

BACKGROUND: Medco Health Solutions, Inc. conducted a project to reduce medication errors in its home-delivery service, which is composed of eight prescription-processing pharmacies, three dispensing pharmacies, and six call-center pharmacies. IMPLEMENTING THE PROJECT: Medco uses the Six Sigma methodology to reduce process variation, establish procedures to monitor the effectiveness of medication safety programs, and determine when these efforts do not achieve performance goals. A team reviewed the processes in home-delivery pharmacy and suggested strategies to improve the data-collection and medication-dispensing practices. A variety of improvement activities were implemented, including a procedure for developing, reviewing, and enhancing sound-alike/look-alike (SALA) alerts and system enhancements to improve processing consistency across the pharmacies. RESULTS: "External nonconformances" were reduced for several categories of medication errors, including wrong-drug selection (33%), wrong directions (49%), and SALA errors (69%). Control charts demonstrated evidence of sustained process improvement and actual reduction in specific medication error elements. DISCUSSION: Establishing a continuous quality improvement process to ensure that medication errors are minimized is critical to any health care organization providing medication services.

Humans↗
PubMedDate not supplied

Factors associated with student nurses' intent to provide physical and psychosocial care to persons with acquired immunodeficiency syndrome.

This project examined the influence of selected factors on student nurses' intent to provide physical and psychosocial care to persons hospitalized with acquired immunodeficiency syndrome (AIDS). Respondents were 125 undergraduate upper division nursing majors attending a state-supported university. Questionnaires were distributed to student mailboxes and were returned anonymously through the United States Postal Service. All factors were correlated with intent to provide physical care and with intent to provide psychosocial care using Pearson product-moment correlation coefficients. For both intention scales, attitude toward a person with AIDS acquired through homosexual activity and attitude toward a person with AIDS acquired through sharing needles were positively related to intent to provide care. Homophobia, fear of AIDS, and perceived susceptibility toward acquiring human immunodeficiency virus from providing care were inversely related. These findings are useful for designing programs that promote the delivery of compassionate nursing care to persons with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Bertha Pappenheim (1859-1936) and her role in nursing care].

In 1954 the German federal postal service issued a special stamp displaying Bertha Pappenheim (1859-1936) in the series "Helfer der Menschheit" (Helpers for mankind) together with Käthe Wollwitz, Lorenz Werthmann und Johann Friedrich Oberlin. Despite being honoured elsewhere, too, her engagement has not been taken note of by any biographers dealing with the history of nursing. This article which conveys a survey of her life and work therefore concentrates primarily on the importance Bertha Pappenheim gave nursing.

Career Choice↗
PubMedDate not supplied

Biological weapons preparedness: the role of physicians.

The real risk posed by biological weapons was demonstrated with the distribution of anthrax spores via the USA postal service in 2001. This review outlines the central roles of physicians in optimizing biopreparedness in Australia, including maintaining awareness of the risk, promptly recognizing an event, notifying appropriate authorities upon suspicion of an event, and instituting appropriate management. Management aspects covered include appropriate diagnostic tests, infection control procedures, and empirical therapy of agents considered possible biological weapons. The critical role of physicians as public health advocates working to prevent the use of biological weapons is also outlined.

Anthrax↗
PubMed2002

Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system.

PURPOSE: The purpose of this study was the assessment of the long-term safety and effectiveness of the Techmedica (Camarillo, CA) CAD/CAM Total Temporomandibular Joint Reconstruction System (now called the TMJ Concepts Patient Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA). PATIENTS AND METHODS: A survey was mailed to the available addresses of 170 (79%) of the 215 patients who had been implanted with the Techmedica System devices between 1990 and 1994. Seventy-nine (46%) surveys were returned by the US Postal Service as undeliverable. Three patients (1.4%) were reported as deceased in returns from relatives. Therefore, of the remaining 91 possible responses, 60 (65.9%) were returned. Fifty-eight (58) surveys, considered complete and valid (96.7%), representing 97 (39 bilateral, 19 unilateral) devices with a mean follow-up of 107.4 +/- 15.5 months (range, 60 to 120 months) were analyzed. Subjective data related to pain, mandibular function, diet consistency, and present quality of life were collected using visual analog scales. Objective measures of mandibular interincisal opening and lateral excursions were obtained from direct measurements using the Therabite (Therabite, Philadelphia, PA) measuring scale provided in the survey with instructions as to its use. RESULTS: Analysis of the subjective data at 10 years revealed a 76% reduction in mean pain scores and a 68% increase in mean mandibular function and diet consistency scores (P <.0001). Analysis of objective data revealed a 30% improvement in mandibular range of motion after 10 years (P =.0009). Long-term quality of life improvement scores were statistically related to the number of prior temporomandibular joint operations the patients had undergone. CONCLUSION: These data indicate that the CAD/CAM Patient Fitted Total Temporomandibular Joint Reconstruction System has proved to be a safe and effective long-term management modality in the patient population surveyed for this study.

Adolescent↗
PubMed1985

New ways in counselling on prenatally diagnosed congenital malformations. An experimental information project using Bildschirmtext/Videotex.

A bibliometric analysis of source items recently published in German-language gynaecology journals and one German-language journal covering a broader field of medicine yielded but one publication linked with prenatally diagnosed congenital malformations and their surgical treatment. Thus, journals usually assessed by the gynaecologist are in this respect at present not a useful source of information for the practitioner outside specialised centres. In order to explore the usefulness of Bildschirmtext (BTX, Videotex), a new electronic medium, as an alternative in counselling for congenital malformations and similar rare medical problems, an experimental database was constructed. Pages giving data on diagnostic pathways, incidence, prognosis, specialised treatment centres and suggested further reading on abdominal wall defects were compiled and are stored in a central computer of the German Federal Postal Services. Data are accessible via the regular telephone network and a specially equipped TV set. The method, although still experimental, is considered useful for offering medical intelligence to the medical professional outside specialised centres.

Abdominal Muscles↗
PubMed1999

Methods for assessing the public health impact of outflows from combined sewer systems.

OBJECTIVES: Approximately 1,100 communities in the United States have combined sewer and stormwater systems whose capacity may be exceeded during moderate or heavy rainfall. Outflows may occur that can deposit water with varying concentrations of the components of sewage onto public areas, where contact with residents or workers is possible, potentially resulting in a range of adverse health effects. This study proposes and applies three analytic methods to evaluate the impact of such outflows on public health. METHODS: The work attendance records of 449 U.S Postal Service letter carriers in Sacramento, CA, were reviewed to determine the frequency of sick leave use (as a surrogate measure of illness) in relationship to rainfall and potential exposure to sewage-contaminated outflows in two distinct groups of letter carriers from October 1, 1992, through April 30, 1993. Rainfall was a surrogate measure of outflows from the combined sewer and stormwater system because no information existed about the extent of exposure of these (or any other) workers. One group of letter carriers delivered mail exclusively within an area served by the combined sewer and stormwater collection system; the second group delivered mail exclusively outside this area where sewage and stormwater collection are separated. The first approach to the assessment of the data was a description of the temporal relationship between rainfall patterns and absentee rates in the two groups of workers. The second approach used logistic regression modelling with varying lags between rainfall and sick leave usage. The third approach used Poisson regression analysis of the entire study period to examine the differential impact of rainfall on the two groups. RESULTS: The descriptive analyses detected no relationship between rainfall and sick leave use. The logistic regression analyses detected evidence (as measured by the interaction coefficient in logistic models) of an increased use of sick leave by the letter carriers within the Combined System area at lag periods of one, four, and five days after rainfall. These estimates were not, however, statistically significant (p > 0.05). The Poisson regression analysis showed no evidence of a differential impact of rainfall on the two groups (incidence rate ratio = 1.19 in both groups for periods of rain versus no rain). CONCLUSIONS: These three methods can be used to investigate the public health impact of combined system outflows. Ideally, however, these approaches would be applied to prospectively collected surveillance data that would rely upon direct measurements of exposure and illness, rather than surrogate variables.

Female↗
PubMed2006

Evaluation of a high-efficiency, filter-bank system.

National Institute for Occupational Safety and Health (NIOSH) investigators evaluated filtration efficiencies at three U.S. Postal Service (USPS) facilities. Ventilation and filtration systems (VFSs) had been installed after the 2001 bioterrorist attacks when the USPS unknowingly processed letters laden with B. anthracis spores. The new VFS units included high-efficiency particulate air (HEPA) filters and were required by USPS contract specifications to provide an overall filtration efficiency of at least 99.97% for particles between 0.3 microm and 3.0 micro m. The USPS evaluation involved a modification of methodology used to test total filtration system efficiency in agricultural tractor cab enclosures. The modified sampling strategy not only proved effective for monitoring the total filtration system component of VFS performance but also distinguished between filtration systems performing to the high USPS performance criteria and those needing repair or replacement. The results clearly showed the importance of choosing a pair of optical particle counters that have been closely matched immediately prior to testing. The modified methodology is readily adaptable to any workplace wishing to evaluate air filtration systems, including high-efficiency systems.

Air Pollution, Indoor↗
PubMed2002

2001 anthrax crisis in Washington, D.C.: clinic for persons exposed to contaminated mail.

An anthrax prophylaxis clinic is described. In October 2001, four workers from the U.S. Postal Service's Brentwood facility in Washington, D.C., were hospitalized with inhalational anthrax; many others may have been exposed to anthrax spores. U.S. Public Health Service (USPHS) teams were deployed to establish an anthrax prophylaxis clinic that would provide education and medication to workers and people who visited the mail facility. The temporary clinic was set up at D.C. General Hospital and was staffed primarily by health care professionals from USPHS. The protocol at the clinic involved three major phases. Phase 1 consisted of gathering information from the patient and distributing educational materials. Phase 2 involved presentations by a physician and a pharmacist concerning anthrax, followed by a question-and-answer session. In phase 3, a pharmacist selected the most appropriate prophylactic agent, dispensed the medication, counseled the patient, and referred patients with flu-like symptoms or skin lesions to a physician. Two floor plans were used to maximize the number of patients seen per hour without jeopardizing patient care. The clinic operated 14 hours a day for 14 days. The 136-member health care team included 52 pharmacists, and medication was dispensed to more than 18,000 patients. The clinic may serve as a model for pharmacists and other professionals in designing and implementing disaster plans. A multidisciplinary team established and operated a clinic to treat persons who may have been exposed to anthrax through contaminated mail.

Ambulatory Care Facilities↗
PubMed1996

Tracking strategies involving fourteen sources for locating a transient study sample: parents of sudden infant death syndrome infants and control infants.

Strategies involving 14 sources were used to locate 230 parents of sudden infant death syndrome infants who died in Southern California between 1989 and 1992 and 255 parents of healthy, living infants matched by birth hospital, birth date, race and sex. The sample consisted of adults of reproductive age residing in Southern California. After an event of sudden infant death, many parents moved without a forwarding address; only their names, last known address, and the infant's race, birth date, and sex were available. There was no access to birth certificates, obstetric or pediatric medical records, parents' Social Security numbers, or parents' birth dates. The most successful tracking sources for case parents were the Department of Motor Vehicles, postal service, reverse directory and neighbors, private investigator, and California Medicaid services. For control parents, the post office, Department of Motor Vehicles, and Folks Finders proved the most helpful. Using a combination of the 14 sources achieved an adequate sample size.

Adult↗
PubMed1993

Isokinetic trunk strength and lifting strength measures. Differences and similarities between low-back-injured and noninjured workers.

Fifty-eight back pain patients and 21 entry-level Postal Service workers without low-back pain were evaluated using a variety of lumbar function measures. Isolated trunk strength and full lifting strength were gauged with isokinetic and isometric methods. Lumbar range-of-motion was computed using toe-touch and goniometers. Conventional clinical techniques such as toe touch and straight leg raise were effective in distinguishing back-injured from normal subjects. Isometric and isokinetic peak force and torque tests failed to show significant differences between low-back pain and job applicant groups. When compared with published norms, our job applicant group was significantly deconditioned. Our data suggest that asymptomatic, deconditioned subjects could be mistaken for back-impaired patients or symptom magnifiers.

Adult↗