Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study

Introduction Intravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps. Methods We conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs. Results Data were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8). Conclusion Errors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations

Intravenous Smart Pumps During Actual Clinical Use: A Descriptive Comparison of Primary and Secondary Infusion Practices

This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication administration delay was compared between a head-height differential system and a cassette system. A total of 301 medication administration observations were included in this study: 102 (34%) for the linear peristaltic IV smart pump (medical–surgical: N = 51; critical care: N = 51) and 199 (66%) for the cassette pump (medical–surgical: N = 88; critical care: N = 111). Results found a 0% compliance for primary line setup and 84% compliance for secondary line setup and 1 omitted medication due to a closed clamp with the linear peristaltic system. For the cassette system, there are no head-height requirements. Two roller clamps were found to be in the closed position on initiation of the secondary infusion, but the clinician was alerted by an alarm, so no medication delays occurred. These findings support that the current system requirements for flow rate accuracy using head-height differential systems are difficult to achieve consistently at the point of care. There is a need for additional human factor designed technology to replace manual actions to improve the process of care for nurses and the safety of care for patients

The BBCH system to coding the phenological growth stages of plants – history and publications –

Die Entwicklungsstadien der wichtigsten Kulturpflanzen wurden in den vergangenen 19 Jahren von zahlreichen Wissenschaftlern nach den Prinzipien der erweiterten BBCH-Skala beschrieben. Die BBCH-Skalen sind inzwischen weltweit bekannt und werden von Wissenschaft, Administration und Praxis in Landwirtschaft und Gartenbau ebenso genutzt, wie in der Phänologie als integrative Wissenschaft im Bereich Umwelt, Meteorologie und Klimatologie. Diese Tatsache weist darauf hin, dass Zielsetzung und Hoffnung, die seit dem Beginn der Arbeit damit verbunden waren, sich erfüllt haben. Die BBCH-Skalen haben sich als hilfreich und praktisch erwiesen. Das Ziel, die Harmonisierung in der Anwendung von Dezimalcodes für die Beschreibung der phänologischen Entwicklungsstadien von Kulturpflanzen und Unkräutern herbeizuführen, wurde erreicht. Sie erfüllten auch die Hoffnung der Initiatoren, damit zur Verbesserung der internationalen agrarwissenschaftlichen und interdisziplinären Kommunikation beizutragen. In der vorliegenden Arbeit soll die Geschichte der BBCH-Skalen aufgezeigt werden, weil diese Einblick in die Hintergründe ihrer Entstehung und Entwicklung erlaubt. Alle Original-Publikationen werden mit ihren Literaturquellen zusammenfassend dargelegt. Die Arbeit soll die unterschiedliche Nutzung der BBCH-Skalen in den verschiedenen wissenschaftlichen Disziplinen dokumentieren. Es soll deutlich werden, dass der weltweite Erfolg der BBCH-Skalen vielen Wissenschaftlern rund um den Globus zu verdanken ist.The growth stages of development of many cultivated plants have been described by numerous scientists according to the principles of the extended BBCH scale within the last 19 years. The BBCH scales are now well- known worldwide and are used by research, administration and practise in agriculture and horticulture, as in the phenology as an integrative science in environment, meteorology and climatology. This fact indicates that the basic objectives and hope have been reached, justifying the practical approach taken by the authors of this scale. The BBCH scale is a contribution to improve the communication between different groups of scientists and to allow the interchange of data and scientific results in a transparent way. The BBCH scales have turned out helpful and practical. The aim to cause the harmonisation in the application of decimal codes for the description of the phenological growth stages of plants and weeds was reached. They also fulfilled the hope of the initiators to contribute with it to the improvement of the international agrarian-scientific and interdisciplinary communication. This paper will describe the history and background of the BBCH scales. The original publications are described and explained with reference of the original literature sources. The paper will describe the different area of use of the scales and list the different scientific disciplines using them. The worldwide success of the BBCH scales is the work of many scientists around the globe

Intravenous Infusion Administration: A Comparative Study of Practices and Errors Between the United States and England and Their Implications for Patient Safety

Introduction Intravenous medication administration is widely reported to be error prone. Technologies such as smart pumps have been introduced with a view to reducing these errors. An international comparison could provide evidence of their effectiveness, including consideration of contextual factors such as regulatory systems and local cultures. Objectives The aim of this study was to investigate similarities and differences in practices and error types involving intravenous medication administration in the United States and England, and summarise methodological differences necessary to perform these parallel studies. Methods We drew on findings of separate point prevalence studies conducted across hospitals in each country. In these, we compared what was being administered at the time of observation with the prescription and relevant policies, errors were classified by type and severity, and proportions of infusions featuring each error type were calculated. We also reviewed what adaptations to the US protocol were needed for England. Authors independently reviewed findings from both studies and proposed themes for comparison. In online meetings, each country’s research team clarified assumptions and explained their findings. Results Key themes included commonalities and contrasts in methods, findings, practices and policies. Although US sites made greater use of smart infusion devices, and had more precisely defined requirements around infusion device use, patterns of errors were similar. Differences among clinical contexts within each country were as marked as differences across countries. Regulatory and quality control systems shape practices, but causal relationships are complex. Conclusion Infusion administration is a complex adaptive system with multiple interacting agents (professionals, patients, software systems, etc.) that respond in rich ways to their environments; safety depends on complex, interrelated factors

Les Forêts actuelles du Sud-Est Belge :Cartographie, inventaire et répartition des principaux types de peuplement

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Thermisme comparé de l'habitat dans la forêt et la prairie permanente (1)

Recherches sur l'écosystème forêt - Série B :La chênaie mélangée calcicole de Virelles-Blaimontinfo:eu-repo/semantics/publishe

Harcèlement sexuel des femmes au travail : préjugés et réalités

Sexuelle Belästigung von Frauen am Arbeitsplatz gehört zu den Formen von Gewalt gegen Frauen, die gesellschaftlich tabuisiert werden. Die Tabuisierung von sexueller Belâstigung perpetuiert und potenziert das Gewalterleben der Frauen im Erwerbsbereich. Ziel einer qualitativen Studie war es deshalb, die gesellschaftlichen Vorurteile, die sexuelle Belästigung zu leugnen, zu verharmlosen und umzudeuten geeignet sind, mit den Schilderungen des subjektiven Erlebens belästigter Frauen zu konfrontieren und aufzuzeigen, dafi die Verschleierung des Gewaltcharakters sexueller Belästigung wesentlich auf der systematischen Ausblendung der Erfahrungs und Interpretationshintergriinde von Frauen beruht, welche spezifische Ereignisse für Frauen zu Gewalterfahrungen werden lassen.The sexual harassment at work is one of the forms of violence which are put under social taboo. This tabuization of sexual harassment perpetuates and intensifies the violence women experience in the world of business. The aim of a qualitative study was thus to contrast the social prejudices which tend to deny, belittle or reinterpret social molestation with an account of the personal experience of sexually- harassed women and to point out that the disguising of the violent nature of sexual molestation is essentially due to the fact that women's experience and interpretation, which lead to the specific occurence of violence, are systematically faded outLe harcèlement sexuel des femmes au travail est une des formes de violence contre les femmes qui sont socialement occultées. Cette occultation perpétue et accroît le vécu de violence des femmes dans le domaine professionnel. Le but de la recherche qualitative présentée était par conséquent de confronter les préjugés sociaux destinés à contester, diminuer et fausser les interprétations du harcè- lement sexuel aux descriptions de leur vécu par les femmes. Il s'agissait aussi de montrer que la dissimulation du caractère violent du harcèlement sexuel repose essentiellement sur l'évacuation systématique de l'expérience et des interprétations féminines de ces événements comme violents.Sexuele intimidatie van vrouwen op het werk is één van de vormen van geweld waarop in de maatschappij nog steeds een taboe rust. Dit maakt dat het geweld dat de vrouwen moeten ondergaan in de arbeidssfeer voorduurt en vers- terkt wordt. Het doel van een kwalitatieve studie was derhalve om de sociale vooroordelen die de sexuele intimidaties ontkennen, bagatelliseren of een andere betekenis geven, te confronteren met de weergave van de persoonlijke ervaring van de lastiggevallen vrouwen. Men wou ook aantonen dat het verzwij- gen van het gewelddadige karakter van de sexuele intimidatie fundamenteel te wijten is aan de systematische uitschakeling van de ervaring en de interpretaties van de vrouwen die de gebeurtenissen als gewelddadig duiden.Schnock Brigitte. Harcèlement sexuel des femmes au travail : préjugés et réalités. In: Déviance et société. 1993 - Vol. 17 - N°3. pp. 261-275

Le bilan de l'eau dans l'écosystème forêt. Application à une chênaie mélangée de haute Belgique

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