Malpractice and patient safety descriptors: an innovative grid to evaluate the quality of clinical records

Introduction: The medical record contains all the health information related to the patient’s clinical condition and its evolution during hospitalization. It was defined by the Italian Ministry of Health in 1992 as "The information tool designed to record all relevant demographic and clinical information about a patient during a single episode of hospitalization". The documents and information in a Medical Record must meet the following criteria: traceability, clarity, accuracy, authenticity, pertinence and completeness. The objectives of our study was to develop a tool capable of assessing the quality of the clinical record and pointed the critical point at the Organizational, Technical - Professional, Managerial level. Methods: To evaluate the quality of the medical documentation, we created an assessment grid composed of 4 sections with a total of 92 criteria. This grid was tested on 200 medical records that were randomly selected from 25 (18 medical and 7 surgical) wards of a teaching hospital in Rome. Results: The grid contains 4 sections. The first part regards administrative and clinical data; the second assesses the quality of hospital stay and surgical/invasive procedures; the third part is concerned with the discharge of the patient and the fourth aims to identify the presence of advisory reports given to the patient. This grid has been validated to verify internal consistency with Cronbach's Alpha = 0,743. Conclusions: Medical records were analyzed using a validated tool with grids to identify critical issues in care activities. Weaknesses in the system were identified in order to improve planning. The sample testing also in terms of ‘self-assessment' represents a tool to introduce activities to improve safety and quality of care, greatly reducing the costs of litigation

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Conley Scale: assessment of a fall risk prevention tool in a General Hospital

Introduction: Umberto I Teaching Hospital adopted 'Scale of Conley' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls.Materials and Methods: Case-control study was performed. Fall events from 1st March 2012 to 30th September 2013 were considered. Cases have been matched for gender, department and period of hospitalization with two or three controls when it is possible. A table including intrinsic and extrinsic fall risk factors, not foreseen by Conley Scale, and setted up after a literature overview was built. Univariate analysis and conditional logistic regression model have been performed.Results: 50 cases and 102 controls were included. Adverse event fall were associated with filled Conley scale at the admission to care unit (OR=4.92, 95%CI= 2.34-10.37). Univariate analysis identified intrinsic factors increasing risk of falls: dizziness (OR= 3.22; 95%CI= 1.34-7.75), psychomotor agitation (OR= 2.61; 95%CI= 1.06-6.43); and use of means of restraint (OR=5.05 CI= 1.77-14.43). Conditional logistic regression model revealed a significant association with the following variables: use of instruments of restraint (HR= 5.54, 95%IC= 1.2-23.80), dizziness (OR= 3.97, 95%CI= 1.22-12.89).Discussion: Conley Scale must be filled at the access of patient to care unit. There were no significant differences between cases and controls with regard to risk factors provided by Conley, except for the use of means of restraint. Empowerment strategies for Conley compilation are needed

Debris flow danger evaluation in the Eastern Alps by integration of numerical simulation and GIS techniques

A methodology for evaluating debris flow danger is proposed. The methodology consist of three steps: (i) field and desk analyses, (ii) numerical simulations of flows based on single-phase model with different rehologies and, (iii) GIS-based danger mapping. In desk and field analyses all the data input for the numerical simulations have been collected. Successively, in the simulations the use of different rehologies allowed account for temporal and spatial variations of debris flow behavior. Finally, outputs of the modelling have been combined by GIS techniques in order to assess debris flow danger. In the next future, research will investigate new combinations of the outputs of numerical simulations for assessing debris flow hazard and the use of codes based on two-phase models will be tested

Suceptibility assay of Candida tropicalis to miconazole

In vitro evaluation of antifungal activity of imidazole derivatives is made difficult by the inhibitory effects of several factors such as inoculum size, growth form of the fungus, incubation temperature, the presence of complex substances, including divalent ions, which strongly influence final results. This is particularly evident when testing clinical isolates of C. tropicalis strains resistant to imidazole drugs. Our data based on assays of miconazole nitrate and miconazole sulfosalicylate against C. tropicalis show that it is possible to abolish various interference activities on the antimicrobial activity by suitable modifications of some cultural conditions. Thus, a study has been carried out to assess miconazole sulfosalicylate activity on C. tropicalis throughout experiments performed by contact test and agar diffusion test. The use of these techniques made it possible to display some activity of the imidazoles even against strains of C. tropicalis, which were defined as resistant using usual susceptibility assay conditions. Experimental conditions which cause the increase of susceptibility of C. tropicalis are related to factors that modify the barrier function and cellular permeability as demonstrated mainly by the effect of electrical conductivity (E.C.), pH of the medium and pretreatment of fungal inoculum with sodium dioctylsulfosuccinate (SDSS). Our results suggest that the correlation between drug dosage and inhibitory activity in vitro can be improved by the modifications proposed in this paper. (C) 1997 Elsevier Science B.V

Propyl gallate increases in vitro antifungal imidazole activity against Candida albicans

We looked at the in vitro effect of an antioxidant, propyl gallate (PG), on the antifungal activity of miconazole sulphosalicylate, econazole sulphosalicylate and ketoconazole against 40 clinical isolates of Candida albicans. The combination of imidazole and PG gave MIC values 10-150 times lower than those of imidazole alone. The optimal conditions for this enhanced activity were pH 6.2-8.0 and a fungal cell concentration lower than 3 x 10(5) cells/ml. The mechanism of the interaction between imidazole and PG is not known but may be as a result of an effect of PG on the P-450 cytochrome. Theoretically this combination could reduce the side effects of long treatment with imidazoles and lower the risk of resistance to these antifungal drugs. (C) 2000 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved

Antifungal activity of Lavandula angustifolia essential oil against Candida albicans yeast and mycelial form

The antifungal activity of the essential oil of Lavandula angustifolia Mill. ( lavender oil) and its main components, linalool and linalyl acetate, was investigated against 50 clinical isolates of Candida albicans ( 28 oropharyngeal strains, 22 vaginal strains) and C. albicans ATCC 3153. Growth inhibition, killing time and inhibition of germ tube formation were evaluated. The chemical composition of the essential oil was determined by gas chromatography and mass spectrometry. Lavender oil inhibited C. albicans growth: mean minimum inhibitory concentration ( MIC) of 0.69% (vol./ vol.) ( vaginal strains) and 1.04% ( oropharyngeal strains); mean MFC of 1.1% ( vaginal strains) and 1.8% ( oropharyngeal strains). Linalool was more effective than essential oil: mean MIC of 0.09% ( vaginal strains) and 0.29% ( oropharyngeal strains); mean MFC of 0.1% ( vaginal strains) and 0.3% ( oropharyngeal strains). Linalyl acetate was almost ineffective. Lavender oil (2%) killed 100% of the C. albicans ATCC 3153 cells within 15 min; linalool (0.5%) killed 100% of the cells within 30 s. The essential oil inhibited germ tube formation ( mean MIC of 0.09%), as did the main components ( MIC of 0.11% for linalool and 0.08% for linalyl acetate). Both the essential oil and its main components inhibited hyphal elongation of C. albicans ATCC 3153 ( about 50% inhibition at 0.016% with each substance). Lavender oil shows both fungistatic and fungicidal activity against C. albicans strains. At lower concentrations, it inhibits germ tube formation and hyphal elongation, indicating that it is effective against C. albicans dimorphism and may thus reduce fungal progression and the spread of infection in host tissues

Conley Scale: assessment of a fall risk prevention tool in a General Hospital

"Umberto I" Teaching Hospital adopted 'Conley scale' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls