Reducing Avoidable Interruptions During the Medication Administration Process

Background: Medication safety and preventing medication errors continues to be a high priority for hospitals and clinics, as medication errors are the most common and most costly errors in U.S. hospitals (Kliger, 2010, p. 690). Kliger (2010) reported that 450,000 medication errors occur annually, costing hospitals approximately $3.5 to 29 billion dollars a year. Furthermore, Ching, Long, Williams & Blackmore (2013) estimated that 770,000 injuries and deaths occur each year as a result of medication errors. Purpose: To decrease medication errors by reducing the number of phone call and call light interruptions during the medication administration process. Methods: Lippitt’s Change Theory was used to address the objective of decreasing medication errors by reducing the amount of phone call interruptions during the medication administration process. Initial audits were completed to observe the medication administration process on the medical-surgical/trauma unit. In addition, nurse surveys were conducted to further assess the opinion and perspective of the nurses working on the unit, and what they felt were the significant interruptions they faced while administering medications. Based on the initial audits and the nurse surveys, the aim of the project was focused on reducing phone call and call light interruptions by educating the unit clerk on how to triage incoming phone calls and call lights. Therefore, in order to reduce the amount of phone call interruptions, a unit clerk packet was created with a unit clerk screening algorithm, overhead script, message sheet, and nurse sign-up sheet. In addition, pre-implementation and post-implementation data was collected on the number of pages and call lights, whether the page or call light was urgent, and whether the nurse was paged or called over the intercom system. Results: The initial medication administration audits demonstrated that interruptions were significant during medication pass time. Furthermore, based on the nurse surveys and secondary audits of the medication administration process, it was found that phone calls were the most common interruption during medication pass time. Following the implementation of the unit clerk packet there was a 32% decrease in the amount of phone call and call light interruptions during the medication administration process. Conclusion: Overall, with the implementation of the unit clerk packet and education of the unit clerk on how to triage phone calls and call lights, it may be concluded that this intervention can decrease the amount of interruptions during the medication administration process. However, medication errors continue to be a problem in U.S. hospitals, thus further research is necessary to investigate how to decrease errors and improve patient safety. It is suggested that further studies should be conducted, and recommendations from the literature should be taken into consideration. Keywords: medication administration, medication errors, interruptions, unit cler

GaAs-GaAlAs distributed-feedback diode lasers with separate optical and carrier confinement

Remarkable reduction of the threshold current density is achieved in GaAs-GaAlAs distributed-feedback diode lasers by adopting a separate-confinement heterostructure. The diodes are lased successfully at temperatures up to 340 °K under pulsed operation. The lowest threshold current density is 3 kA/cm^2 at 300 °K

Presupernova evolution and explosive nucleosynthesis of zero metal massive stars

We present a new set of zero metallicity models in the range 13-80 $\rm M_\odot$ together to the associated explosive nucleosynthesis. These models are fully homogeneous with the solar metallicity set we published in Limongi & Chieffi (2006) and will be freely available at the web site http://www.iasf-roma.inaf.it./orfeo/public{\_}html. A comparison between these yields and an average star that represents the average behavior of most of the very metal poor stars in the range $\rm -5.0<[Fe/H]<-2.5$ confirms previous findings that only a fraction of the elemental [X/Fe] may be fitted by the ejecta of $\it standard$ core collapse supernovae.Comment: 39 pages, 8 figures, 2 tables, accepted for publication in ApJ

Liquid phase epitaxy of GaAlAs on GaAs substrates with fine surface corrugations

Liquid phase epitaxy of GaAlAs was performed on GaAs fine surface corrugations. By optimizing the growth conditions, GaAlAs layers were grown successfully with only minimal meltback

Inverse opal ceria–zirconia: architectural engineering for heterogeneous catalysis

The application of inverse opal structured materials is extended to the ceria–zirconia (Ce_(0.5)Zr_(0.5)O_2) system and the significance of material architecture on heterogeneous catalysis, specifically, chemical oxidation, is examined

Charmonium dissociation temperatures in lattice QCD with a finite volume technique

Dissociation temperatures of J/\psi, \psi', and \chi_c states play key roles in the sequential J/\psi suppression scenario for high energy heavy ion collisions. We report on a study of charmonium dissociation temperatures in quenched lattice QCD. On anisotropic lattices, we first subtract the effects of the constant mode in finite temperature meson correlators, which have lead to unphysical results in previous studies. We then extract ground and first exited state masses by diagonalizing correlation functions among different source and sink operators. To distinguish bound states from scattering states, we first compare the charmonium mass spectra under different spatial boundary conditions, and examine the shape and the volume-dependence of their Bethe-Salpeter wave functions. From these studies, we found so far no sign of scattering states up to about 2.3T_c.Comment: 4pages, 2figures, proceedings of Quark Matter 2008 (QM2008), Jaipur, India, Feb 4-10, 200

The Connection between Gamma-Ray Bursts and Extremely Metal-Poor Stars: Black Hole-forming Supernovae with Relativistic Jets

Long-duration gamma-ray bursts (GRBs) are thought to be connected to luminous and energetic supernovae (SNe), called hypernovae (HNe), resulting from the black-hole (BH) forming collapse of massive stars. For recent nearby GRBs~060505 and 060614, however, the expected SNe have not been detected. The upper limits to the SN brightness are about 100 times fainter than GRB-associated HNe (GRB-HNe), corresponding to the upper limits to the ejected $^{56}$Ni masses of $M({\rm ^{56}Ni})\sim 10^{-3}M_\odot$. SNe with a small amount of $^{56}$Ni ejection are observed as faint Type II SNe. HNe and faint SNe are thought to be responsible for the formation of extremely metal-poor (EMP) stars. In this Letter, a relativistic jet-induced BH forming explosion of the 40 $M_\odot$ star is investigated and hydrodynamic and nucleosynthetic models are presented. These models can explain both GRB-HNe and GRBs without bright SNe in a unified manner. Their connection to EMP stars is also discussed. We suggest that GRBs without bright SNe are likely to synthesize \Mni\sim 10^{-4} to $10^{-3}M_\odot$ or $\sim 10^{-6}M_\odot$.Comment: 7 pages, 3 figures. Accepted for publication in the Astrophysical Journal Letters (10 March 2007, v657n2 issue

Heavy-light meson in anisotropic lattice QCD

We examine whether the $O(a)$ improved quark action on anisotropic lattices can be used as a framework for the heavy quark, which enables precision computation of matrix elements of heavy-light mesons. To this end, it is crucial to verify that a mass independent and nonperturbative tuning of the parameters is possible. As a first step, we observe the dispersion relation of heavy-light mesons on a quenched lattice using the action which is nonperturbatively tuned only for the leading terms. On a lattice with the spatial cutoff $a_\sigma^{-1} \simeq$ 1.6 GeV and the anisotropy $\xi=4$, the relativity relation holds within 2% accuracy in the quark mass region $a_\sigma m_Q \leq 1.2$ with the bare anisotropy parameter tuned for the massless quark. We also apply the action to a calculation of heavy-light decay constants in the charm quark mass region.Comment: Lattice2002(heavyquark), 3 pages, 2 figure

Charmed hadron physics in quenched anisotropic lattice QCD

We investigate the anisotropic lattice with $O(a)$ improved quark action as a candidate of framework in which we can treat both the heavy and light quark region in the same manner and systematically reduce the systematic uncertainties. To examine applicability of anisotropic lattice, we calculate the charmed meson spectrum and decay constants in quenched approximation. We find consistent result with most advanced results on isotropic lattices.Comment: 3 pages, 1 figure, contribution to Fifth KEK Topical Conference - Frontiers in Flavor Physics -, Tsukuba, Japan, November 20-22, 200

Solute channels of the outer membrane: from bacteria to chloroplasts

Chloroplasts, unique organelles of plants, originated from endosymbiosis of an ancestor of today's cyanobacteria with a mitochondria-containing host cell. It is assumed that the outer envelope membrane, which delimits the chloroplast from the surrounding cytosol, was thus inherited from its Gram-negative bacterial ancestor. This plastid-specific membrane is thus equipped with elements of prokaryotic and eukaryotic origin. In particular, the membrane-intrinsic outer envelope proteins (OEPs) form solute channels with properties reminiscent of porins and channels in the bacterial outer membrane. OEP channels are characterised by distinct specificities for metabolites and a quite peculiar expression pattern in specialised plant organs and plastids, thus disproving the assumption that the outer envelope is a non-specific molecular sieve. The same is true for the outer membrane of Gram-negative bacteria, which functions as a permeability barrier in addition to the cytoplasmic membrane, and embeds different classes of channel pores. The channels of these prokaryotic prototype proteins, ranging from unspecific porins to specific channels to ligand-gated receptors, are exclusively built of P-barrels. Although most of the OEP channels are formed by P-strands as well, phylogeny based on sequence homology alone is not feasible. Thus, the comparison of structural and functional properties of chloroplast outer envelope and bacterial outer membrane channels is required to pinpoint the ancestral OEP `portrait gallery'