International Journal of Risk & Safety in Medicine - Volume 22, issue 3

Authors: Sollid, Stephen J.M. | Eidesen, Karianne | Aven, Terje | Søreide, Eldar

Article Type: Research Article

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. Show more

Keywords: Critical care, tracheostomy, percutaneous, patient safety, risk assessment

DOI: 10.3233/JRS-2010-0500

Citation: International Journal of Risk & Safety in Medicine, vol. 22, no. 3, pp. 115-129, 2010

Authors: Ernst, E.

Article Type: Research Article

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. Show more

Keywords: Acupuncture, risks, harm, death, alternative medicine, evidence

DOI: 10.3233/JRS-2010-0503

Citation: International Journal of Risk & Safety in Medicine, vol. 22, no. 3, pp. 131-136, 2010

Authors: See, Lai-Chu | Peng, Pei-I. | Lin, Na-Ling | Lai, Hui-Ju | Chang, Yi-Hua | Jean, Wen-Chyi | Wang, Chao-Hui

Article Type: Research Article

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. Show more

Keywords: Safe use of medication, education multimedia, patients and family members

DOI: 10.3233/JRS-2010-0504

Citation: International Journal of Risk & Safety in Medicine, vol. 22, no. 3, pp. 137-148, 2010

Authors: Breggin, Peter R.

Article Type: Research Article

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 [9], 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. Show more

Keywords: Antidepressants, military, stress, PTSD, FDA, suicide, violence, mania, antidepressant adverse drug reactions

DOI: 10.3233/JRS-2010-0502

Citation: International Journal of Risk & Safety in Medicine, vol. 22, no. 3, pp. 149-157, 2010

Authors: Shortt, S.E.D. | Green, Michael F. | Corbett, Stan | Paquette, Laure | Zurba, Nadia | Darling, Margaret

Article Type: Research Article

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. Show more

Keywords: Patient safety, quality of care, physicians, governance

DOI: 10.3233/JRS-2010-0501

Citation: International Journal of Risk & Safety in Medicine, vol. 22, no. 3, pp. 159-168, 2010