Application of Lean Six Sigma in Reduction of Medication Errors

This study focuses on reduction of medication errors by application of lean Six Sigma approach in Medication administration by nurses in a corporate chain hospital of India. It helped the hospital to understand the impact of dedicated Medication Nurse on the Medication administration error rate. the purpose of the research is to redesign the policy on medication administration i.e. introducing the concept of Medication nurse for the management of medication administration errors and depletion of interruptions faced in medication delivery in order to improve the efficiency, effectiveness and safety of care delivered to patients. as per the study done on medication administration, the medication error rate found was very high in a ward (mostly contributing were 31% of missed dose, 21% of wrong dose and 17% at wrong time) due to many interruptions and challenges faced by nurses during drug administration which in turn affecting the safety of care delivered to the patients and total medication delivery time taken by a general nurse was 9 minutes. By using the lean Six sigma methodology, it was observed rate of medication errors was decreased, the complexity of the work flow became simple and systematic, the work load on all nurses was decreased, and the average time for drug administering was decreased by 55% i.e. to 4 minutes in three months. thus, it helped in reducing mess up and complexity in the ward with better utilization of other nurses to perform other activities which are needed to be done at the same time and delivering best quality of patient care with high efficiency

Obstructive mullerian anamolies: a case series

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly

An Estimation of Dynamic Properties of Soils from Block Vibration Tests

The paper presents departures that have to be made in the conduct of block vibration tests from the standard method and in the analysis of test data under unusual conditions. Disturbed soil condition under an edge of the block leads to occurrence of double peaks in amplitude versus frequency curves from vertical vibration test. Two methods have been devised to analyze such double peaks. The first method assumes a correlation between dynamic coefficients. The dynamic properties can be predicted from non-dimensional curves of correction factor versus ratio of effective base area. The second method assumes linear variation of coefficient of elastic uniform compression and its maximum value is estimated from non-dimensional curves of correction factor versus ratio of frequencies at first and second peaks. Comparison of results of a repeat test under near-ideal conditions with corrected values of soil parameters confirms the adequacy of the presented methods

Correlation of clinical, biochemical and radiological characteristics with histopathology of ovarian masses: hospital based descriptive study

Background: Ovarian cancer is an important cause of morbidity and mortality in the middle aged women. A systematic study of all ovarian tumours encountered in a large institute over a period of years is more likely to produce a significant amount of useful data regarding the clinical manifestations, the incidence of various types of ovarian tumours and the type of treatment offered. In this study we correlate various clinical presentations, ultrasound features, and various tumour marker levels with histopathology of ovarian masses.Methods: The study was conducted in the department of obstetrics and gynaecology in collaboration with department of radiology and pathology and lab medicine, Deen Dayal Upadhyay hospital from April 2015 to December 2016.Results: In the present study, 97 ovarian masses have been operated out of total 708 gynaecological surgeries in the obstetrics and gynaecology department of Deen Dayal Upadhyay hospital over the stipulated period. Prevalence of ovarian masses was 13.7%. Most of the ovarian masses were prevalent in the reproductive age group i.e. 21-40 years of age group in the present study though malignant masses were commonest in post-menopausal age group in the present study. 2 out 11 malignant ovarian masses were in the age group of 10-20 years which were dysgerminoma and immature teratoma respectively. Intra-operative findings like presence of mural nodule, haemorrhage and necrosis, ascites, papillary excrescences and omental caking were also found to have strong correlation with malignancy.Conclusions: A detailed preoperative workup and a simple tool loke RMI can differentiate between benign and malignant masses pre-operatively especially in post-menopausal women

Soil-Structure Interaction and Aseismic Design of a Stadium Building

The paper presents case history of a reinforced concrete stadium building which had been structurally designed for a particular component configuration and also constructed upto seating level and which was referred to the author for suggesting structural modifications and redesigning for different configuration which meant curtailing middle two main columns each above the seating level out of four columns in each of left and right halves of the building. The required modifications necessitated analysis of the modified frame under static loads taking into account soil-structure interaction. The other problem to be tackled was ensuring lateral stability with reduced number of main columns, which are slender and have restriction in size, under earthquake conditions. Since the structure could have free vibrations in coupled translation and yawing, advantage has been taken of stiffness of rear columns whose size was not restricted

In-Situ Determination of Dynamic Properties of Soil for Foundation of a Turbo-Generator

The paper presents a case history of performance and analysis of results of vertical & horizontal resonance tests on a standard concrete block in a well, for in-situ determination of dynamic properties of soil required for design of a turbo-generator, under unusual conditions of high water table. Pumping from the two wells constructed for lowering the water level was not enough and pumping from within the main well had to be resorted to bring down the water level to a little below the top surface of the model block. As expected, amplitude versus frequency curves for vertical resonance test showed two resonant peaks instead of one, indicating occurrence of two modes of vibration. A method for estimating dynamic co-efficients of soil, through derived curves for ratio of natural frequencies in horizontal and vertical modes versus effective area of base, has been suggested. A repeat test under good conditions confirmed the adequacy of the method

Levonorgestrel intrauterine releasing system: long term health impact

Background: Menorrhagia, menstrual blood loss of more than 80 ml is a common health problem affecting 5-30% of women in India and accounts for 8% loss of economic wages annually. This study was conducted in PGIMER and Dr. RML Hospital New Delhi to evaluate the efficacy, acceptability and safety profile of LNG IUS (a non-invasive modality) in a variety of gynaecological disorders with associated menorrhagia.Methods: This was a noncomparative longitudinal observational study conducted in PGIMER and Dr RML Hospital New Delhi from June 2009 to September 2013.All patients with menorrhagia with or without dysmenorrhoea were screened and in suitable cases, LNG IUS was inserted in the postmenstrual phase after counselling and informed consent. Menstrual pattern, mean bleeding days, hemoglobin and satisfaction level was noted before insertion, 6 months, 1 year and 2 years post insertion.Results: 30 patients were recruited in the study over the first 2 years. 66.66% (20) had associated medical co morbidities. LNG IUS was spontaneously expelled in 2 (6.66%) and 3 subjects (10%) needed a hysterectomy due to persistent bleeding. The remaining 25 subjects continued with the device and these subjects had a significant decrease in mean bleeding days with associated significant rise in hemoglobin levels over 2 years.Conclusions: LNG-IUS is an underused useful device for several gynecological disorders and is a boon especially for those with medical comorbidities and should be offered to all suitable subjects.

Start your engines: automobile exports, comparing India and China

Relying much more heavily on domestically grown lead-firms, India’s car manufacturing industry, in contrast to China’s, has benefited at a slower pace from global best-practices

Fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis

Background: The objective of this study was to determine fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis.Methods: This study was prospective observational descriptive study of 130 women, which was conducted in the department of obstetrics and gynaecology, Deen Dayal Upadhayay Hospital, New Delhi. Statistical analysis was performed using the z test when appropriate. A p value of <0.05 will be considered statistically significant.Results: Spontaneous onset of labour was present in 48.5% of patients, induction was done in 31.5% of patients and in rest 20% of patients LSCS was indicated. Normal vaginal delivery occurred in 97 of 130 patients while emergency LSCS done 33 of 130 patients. Emergency LSCS was done in 16 of 33 patients due to foetal distress. Pre-term delivery and PROM occurred in 8.5% and 9.2% of patients respectively while PPH occurred in 12.3% of patients. Among the 130 cases included in present study 34 patients (27.2%) had fetal distress, 41 patients (31.5%) had MSL and 40 neonates (32.0%) required NICU. 16 neonates out of 130 (12.8%) had birth weight below 2.5 kg. Apgar score was <7 after 5 min in 31 neonates.Conclusions: Ursodeoxycholic acid (UDCA) is useful in relieving symptoms and decreasing the biochemical markers.