An exploratory study measuring verbal order content and context
ABSTRACT The use of verbal orders, while essential in some healthcare settings, has been identified as a potential contributor to poor quality and less safe care. Despite the widespread use of verbal orders, little research attention has been paid to understanding and measuring the content of verbal orders or variables related to the context in which verbal orders are made.
This paper first identifies variables related to verbal order content and context, and then provides detailed analyses from two exploratory studies conducted in one community hospital.
The data presented were collected using both a paper-based manual audit, and an analysis of data generated from a computerised order entry system.
Selected analyses focus of variations in types and timing of verbal orders hospital-wide as well as for specific inpatient units, changes in verbal order utilisation following implementation of a computerised provider order entry system, and an analysis of the presence of sound-alike and high-alert medications in verbal orders.
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ABSTRACT: Although verbal and telephone orders (VOs) are commonly used in the patient care process, there has been little examination of the strategies and tactics used to ensure their appropriate use or how to ensure that they are accurately communicated, correctly understood, initially documented, and subsequently transcribed into the medical record and ultimately carried out as intended. A systematic review was conducted of hospital verbal and telephone order policies in acute care settings. A stratified random sample of hospital verbal and telephone order policy documents were abstracted from critical access, rural, rural referral, and urban hospitals located in Iowa and Missouri and from academic medical centers from across the United States. Substantial differences were found across 40 acute care settings in terms of who is authorized to give (including nonlicensed personnel) and take VOs and in terms of time allowed for the prescriber to cosign the VO. When a nonphysician or other licensed prescriber was allowed to communicate VOs, there was no discussion of the process to review the VO before it was communicated in turn to the hospital personnel receiving the order. Policies within several of the same hospitals were inconsistent in terms of the periods specified for prescriber cosignature. Few hospitals required authentication of the identity of the person making telephone VOs, nor the use of practices to improve communication reliability. Careful review and updating of hospital VO policies is necessary to ensure that they are internally consistent and optimize patient safety. The implementation of computerized medical records and ordering systems can reduce but not eliminate the need for VOs.Joint Commission journal on quality and patient safety / Joint Commission Resources 01/2012; 38(1):24-33.
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ABSTRACT: Some papers have been recently presented (Cunto and Saccomanno, 2007; Cunto and Saccomanno, 2008; Saccomanno et al., 2008) on the potential of traffic microsimulation for the analysis of road safety. In particular, studies have confirmed that the reproduction by simulation of user behaviour under different flow and geometric conditions, can identify a potential incident hazard and allow to take appropriate countermeasures at specific points of the road network. The objective of this paper is to assess the validity of this approach and present a new methodology for investigating road safety issues. A calibrated microsimulation model has been developed to analyze vehicle trajectories, and hence vehicle interactions, in some different scenarios and verify traffic safety levels. The microscopic model allows the estimation of road safety performance through a series of indicators (Crash Potential Index, Deceleration Rate to Avoid Crash, Maximum Available Deceleration Rate, Time to Collision, etc.), representing interactions in real time between different pairs of vehicles belonging to the traffic stream. When these indicators take a certain critical value, a possible accident scenario is identified. The validation of the proposed methodology can be done by comparing the value assumed by safety performance indicators in simulated and real scenarios. The microscopic simulation model is also combined with a new video image traffic detection algorithm to detect vehicle trajectories. Microscopic traffic flow parameters obtained by video detection are, in fact, used to calibrate the microsimulation model. The above described methodology has been applied in the analysis of overtaking maneuvers on single lane for direction fast rural roads. Results indicate that the methodology can be useful in the estimation of safety performance indicators and in evaluating traffic control measures.Procedia - Social and Behavioral Sciences 01/2011; 20:226-235. DOI:10.1016/j.sbspro.2011.08.028