International Journal of Risk & Safety in Medicine - Volume 22, issue 3
Purchase individual online access for 1 year to this journal.
Price: EUR 155.00
The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: Background and objective: Probabilistic risk assessment methods are well suited for exploring hazards and threats in patient care due to their ability to analyse complex systems and include human factors. Adopting an event (A) – consequence (C) – uncertainty (U) perspective (referred to as the (A, C, U) perspective) the focus of the risk assessment is on predictions and uncertainty assessment of observable quantities. Uncertainty is the main component of risk, and probability is a tool for expressing this uncertainty. To demonstrate the feasibility of this perspective in risk assessment to improve patient safety, we have applied it to the…high-risk activity of percutaneous dilatational tracheostomy in an intensive care unit. Methods: Using a Bayesian belief network, we modelled and analysed fault trees of two relevant adverse events: “Perioperative bleeding” and “loss of airway”. The analysis was based on a broad knowledge basis and incorporated risk influencing factors. Results: In the risk assessment we assigned the probability of “perioperative bleeding” at 8.0% and “loss of airway” at 0.05%. The uncertainty assessment identified operator and team performance to affect risk the most. Conclusion: Risk assessment according to the (A, C, U) perspective is a valuable tool to support decision-making in patient safety matters and explore risk influencing factors.
Keywords: Critical care, tracheostomy, percutaneous, patient safety, risk assessment
Abstract: Context: Several fatalities after acupuncture have been reported. But no critical analysis of these data is currently available. Objective: This systematic review is aimed at summarizing these reports and putting them into a broader context. Data sources: Four electronic databases and my own files were searched for such reports. No restrictions in terms of language or time were imposed. Study selection: Case reports, case series and other types of articles reporting fatalities were considered. Data extraction: Key data were extracted according to pre-defined criteria. Results: Reports of 86 deaths after acupuncture were found. Many are incomplete and causality may therefore…be occasionally uncertain. Due to under-reporting, these reports are likely to merely describe the tip of a larger iceberg. Conclusion: Acupuncture has been associated with numerous deaths. These fatalities are avoidable and a reminder of the need to insist on adequate training for all acupuncturists.
Keywords: Acupuncture, risks, harm, death, alternative medicine, evidence
Abstract: Background: Programs for improving safety in medication often ignore the patient’s perspective although patients are usually the victims of medication errors. Therefore, educating patients or family members to participate in safety prevention on medication use during care delivery is essential. The aim was to develop a computer education multimedia on patient’s safe use of medication, and evaluate its acceptability and short-term effect. Methods: The one group pre- and post-training design was used in outpatient or inpatient setting at Chang Gung Memorial Hospital, where located at northern Taiwan. A questionnaire about the past and future practice of medication use, and their…satisfaction towards the multimedia was asked. Results: One hundred twenty two participants were enrolled. The score of pretest were higher in family members than that in the patients (p = 0.0152). After showing the education multimedia, significant increase on the posttest was seen in both the patients (0.43 ± 0.6, p < 0.0001) and the family members (0.32 ± 0.6, p < 0.0001). Overall satisfaction was 98.2%. Conclusion: Our education multimedia had short-term effect on raising the participants’ awareness towards the safe use of medication. Their satisfaction of the multimedia was very high.
Keywords: Safe use of medication, education multimedia, patients and family members
Abstract: The newer antidepressants frequently cause suicide, violence and manic-like symptoms of activation or over-stimulation, presenting serious hazards to active duty soldiers who carry weapons under stressful conditions. These antidepressant-induced symptoms of activation can mimic Post Traumatic Stress Disorder (PTSD) and are likely to worsen this common disorder in soldiers, increasing the hazard when they are prescribed to military personnel. Antidepressants should not be prescribed to soldiers during or after deployment. Recently concern has been expressed about the increased prescription of psychiatric medications, especially antidepressants, to military personnel [46, 57]. In presentations at military conferences on combat stress [8, 10] and…in testimony before the U.S. House of Representatives Veterans Affairs Committee , I have pointed to a probable causal relationship between increasing rates of antidepressant prescription and increasing rates of suicide in the military. This paper reviews and evaluates the relevant scientific data.
Abstract: Health care quality and safety is a public policy issue. In the past, issues of quality of care have been largely delegated to the medical profession. Now, however, governments may wish to assume a more active role and will need to know what governance tools are likely to be effective. This paper reviews the evidence on effectiveness for seven processes for governing the physician sector: informing; guiding; educating; reporting; incentivizing; re-licensing; and punishing. There is good evidence for modest to moderate effectiveness of the first three approaches, scant evidence for the next two, and no empirical data on the final…two.
Keywords: Patient safety, quality of care, physicians, governance