Using nurses and office staff to report prescribing errors in primary care

Objective. To implement a prescribing-error reporting system in primary care offices and analyze the reports. Design. Descriptive analysis of a voluntary prescribing-error-reporting system Setting. Seven primary care offices in Vermont, USA. Participants. One hundred and three prescribers, managers, nurses and office staff. Intervention. Nurses and office staff were asked to report all communications with community pharmacists regarding prescription problems

How Physicians Draw Satisfaction and Overcome Barriers in their Practices: “It Sustains Me”

Objective Major reorganizations of medical practice today challenge physicians’ ability to deliver compassionate care. We sought to understand how physicians who completed an intensive faculty development program in medical humanism sustain their humanistic practices. Methods Program completers from 8 U.S. medical schools wrote reflections in answer to two open-ended questions addressing their personal motivations and the barriers that impeded their humanistic practice and teaching. Reflections were qualitatively analyzed using the constant comparative method. Results Sixty-eight physicians (74% response rate) submitted reflections. Motivating factors included: 1) identification with humanistic values; 2) providing care that they or their family would want; 3) connecting to patients; 4) passing on values through role modelling; 5) being in the moment. Inhibiting factors included: 1) time, 2) stress, 3) culture, and 4) episodic burnout. Conclusions Determination to live by one’s values, embedded within a strong professional identity, allowed study participants to alleviate, but not resolve, the barriers. Collaborative action to address organizational impediments was endorsed but found to be lacking. Practice implications Fostering fully mature professional development among physicians will require new skills and opportunities that reinforce time-honored values while simultaneously partnering with others to nurture, sustain and improve patient care by addressing system issues

Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study

Contains fulltext : 97252.pdf (publisher's version ) (Open Access)BACKGROUND: Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented. METHODS: We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded. RESULTS: We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death. CONCLUSIONS: Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice

Intervenir sobre la cultura organizacional: ¿qué aspectos se pueden considerar?

La cultura organizacional (co) es un macroconstructo que involucra una gran variedad de componentes y funciones organizacionales (Warner, 2014). Reyes y Moros (2018) señalan que tiene su origen en el estudio realizado en Hawthorne por Elton Mayo y otros investigadores de la Escuela de las Relaciones Humanas de la Administración, en el que buscaban identificar la influencia de las condiciones físicas y ambientales en el desempeño individual. Para Reyes y Moros (2018), la co se siguió desarrollando en los años setenta con Pettigrew, para ser entendida como un sistema de significados que tanto pública como colectivamente es aceptado para operar en un tiempo y por un grupo determinado. Los autores la definen como “… un sistema de significados compartidos por los miembros de la organización, los cuales son el resultado de una construcción social constituida a través de símbolos y como tal deben ser interpretados”1a edició

Polyculture, autonomy, and community: the pursuit of sustainability in a northern Thai farming village

A growing body of literature tracks small farmers worldwide engaging in new, proactive forms of ecologically oriented mobilization in a quest for community sustainability. We present the case of a group of farmers in northern Thailand who have converted from high-input, export-focused commodity crop production to organic vegetable polyculture systems. We analyse their motivations and the effects these changes have had on their households and community and find similarities with other small-scale agrarian communities reclaiming peasant modes of farming. The farmers of Mae Ta are primarily driven by an increased aversion to the cycles of debt, poor health, and restricted autonomy that accompany industrialized production. Those who have transitioned to organic polyculture have largely rid themselves of cyclical debt and persistent health maladies, feel more empowered and satisfied in their farming systems, and speak of broader impacts on the overall community

Practical Wisdom And Health Care

Healthcare in the developed world increasingly involves managing chronic conditions rather than curing acute ones. And managing chronic conditions typically requires that patients be partners rather than merely complaint executers of medical directives. To foster and sustain such partnerships, medical practitioners must possess not only technical competence, but moral competence. Medical education must be education in character—in virtue—and the cardinal virtue that must be educated is practical wisdom. We describe three institutional settings—inner-city health clinics, a program in medical education, and a program in a major medical center that provides palliative care—in which virtue education is taken as seriously as medical education, with good results for both the patients and the staff. Improving the health outcomes of an aging population will require that medical institutions commit themselves to allowing virtue to be nurtured and deployed